bluuebunny/crossref_metadata_2025 huggingface dataset:
Microstructure and optical properties of sputter-deposited Ga2O3 films
Authors: Vega Eduardo , Isukapati Sundar B. , Oder Tom N.
Published: April 2021

We report on the properties of gallium oxide (Ga2O3) thin films deposited on c-plane sapphire substrates using radio frequency magnetron sputtering under various conditions. The parameters varied included the composition of the deposition gas, the substrate temperature, and postdeposition annealing temperature. The optical characteristics obtained by UV-VIS spectroscopy showed excellent transparency of 90%–95% for all the films obtained. The structural and compositional properties of the films were determined using x-ray diffraction and energy dispersive spectrometry measurements. The films deposited in Ar at 400 °C showed diffraction peaks at 18.6°, 37.2°, and 58.2°, which are attributed to diffraction peaks from (2¯01), (4¯02), and (6¯03) planes of β-Ga2O3. Postdeposition annealing in N2 at 400–900 °C did not make any improvement in the crystalline quality of the films. The addition of tin in the films produced transparent films whose optical bandgaps decreased with increasing tin concentration in the films.
Schrödinger's equation as a diffusion equation
Authors: Mita Katsunori
Published: April 2021

Schrödinger's equation can be considered as a diffusion equation with a diffusion coefficient β2=ℏ/2m. In this article, we explore the implications of this view. Rewriting the wave function in a polar form and transforming Schrödinger's equation into two real equations, we show that one of them reduces to the continuity equation, and the other, a nonlinear dynamical equation for the probability density. Considering these two equations as if they were the basic equations of quantum mechanics, we apply them to several one-dimensional quantum systems. We show the dispersive properties in the probability densities of stationary states of a particle in a rigid box and in harmonic potential; quasi-classical Gaussian probability densities of a free particle; and coherent states and squeezed states of the harmonic oscillator. We also present the soliton as a quantum mechanical representation of a free particle. We discuss the meaning of the diffusion coefficient β2 for each quantum system using a density plot.
Two-body bound states through Yukawa forces and perspectives on hydrogen and deuterium
Authors: Ennes Henrique L. , Gresham Moira I. , Shaw Alexander F.
Published: April 2021

We present and discuss numerical solutions to a two-body quantum bound state problem closely related to that of the hydrogen atom and the deuterium nucleus. The forces binding the particles of our system are Yukawa forces, which fall off with distance faster than the Coulomb force and arise for non-relativistic particles whose interactions are mediated by massive scalar or vector particles; the Coulomb force arises in the limit of massless mediators such as photons. We use the solutions to explain several features of deuterium. We also present heuristic estimates of ground state energies and energy level degeneracy breaking. Studying this Yukawa two-body system provides insights into hydrogen, deuterium, and two-body bound states, generally. We describe our undergraduate-accessible procedure for numerically solving non-relativistic two-body bound state problems with mathematica in the appendix.
Application of the Helfrich elasticity theory to the morphology of red blood cells
Authors: Martínez-Balbuena L. , Arteaga-Jiménez A. , Hernández-Zapata E. , Urrutia-Buñuelos E.
Published: April 2021

In this work, we present in detail, in an accessible manner for undergraduate and graduate physics students, the model of spontaneous curvature, due to Helfrich, that quantitatively explains why the red blood cells in their natural state adopt a biconcave shape. The main hypothesis is that the equilibrium cell shape satisfies the principle of minimum free energy. Therefore, in the model, an expression for the membrane free energy is postulated based on the Helfrich theory. In that approximation, the membrane is modelled as a two-dimensional surface and the energy is written as a function of the surface principal curvatures and three parameters, including the spontaneous curvature, c0, which is associated with the chemical composition of the membrane. The negative values for c0 induce invaginations in the cell membrane. The model predicts the discocyte-spherocyte transition for the red blood cell. In the article, the concepts involved in the theory are developed in detail, and an algorithm that allows obtaining the contour of the cell is presented in detail as supplementary material.
Magnetic diffusion, inductive shielding, and the Laplace transform
Authors: Krosney Alexander E. , Lang Michael , Weirathmueller Jakob J. , Bidinosti Christopher P.
Published: April 2021

In the quasistatic limit, a time-varying magnetic field inside a conductor is governed by the diffusion equation. Despite the occurrence of this scenario in many popular physics demonstrations, the concept of magnetic diffusion appears not to have garnered much attention itself as a subject for teaching. We employ the model of a thin conducting tube in a time-varying axial field to introduce magnetic diffusion and connect it to the related phenomenon of inductive shielding. We describe a very simple apparatus utilizing a wide-band Hall-effect sensor to measure these effects with a variety of samples. Quantitative results for diffusion time constants and shielding cutoff frequencies are consistent with a single, sample-specific parameter given by the product of the tube radius, thickness, and electrical conductivity. The Laplace transform arises naturally in regard to the time and frequency domain solutions presented here, and the utility of the technique is highlighted in several places.
The Effectiveness of a 30-Week Concurrent Strength and Endurance Training Program in Preparation for an Ultra-Endurance Handcycling Challenge: A Case Study
Authors: Nevin Jonpaul , Smith Paul
Published: April 2021

Purpose: The aim of the following case study was to evaluate the effectiveness of a 30-week concurrent strength and endurance training program designed to prepare a trained H4 male handcyclist (aged 28 y, bilateral, above knee amputee, and body mass 65.6 kg) for a 1407-km ultra-endurance handcycling challenge. Methods: This observational case study tracked selected physiological measures, training intensity distribution, and total training load over the course of a 30-week concurrent training protocol. Furthermore, the athlete’s performance profile during the ultra-endurance challenge was monitored with power output, cadence, speed, and heart rate recorded throughout. Results: Findings revealed considerable improvements in power output at a fixed blood lactate concentration of 4 mmol·L−1 (+25.7%), peak aerobic power output (+18.9%), power-to-mass ratio (+18.3%), relative peak oxygen uptake (+13.9%), gross mechanical efficiency (+4.6%), bench press 1-repetition maximum (+4.3%), and prone bench pull 1-repetition maximum (+14.9%). The athlete completed the 1407-km route in a new handcycling world record time of 89:55 hours. Average speed was 18.7 (2.1) km·h−1; cadence averaged 70.0 (2.6) rpm, while average power output was 67 (12) W. In terms of internal load, the athlete’s average heart rate was 111 (11) beats per minute. Conclusion: These findings demonstrate how a long-term concurrent strength and endurance training program can be used to optimize handcycling performance capabilities in preparation for an ultra-endurance cycling event. Knowledge emerging from this case study provides valuable information that can guide best practices with respect to handcycling training for ultra-endurance events.
Understanding Season Ticket Holder Attendance Decisions
Authors: Karg Adam , Nguyen Jeremy , McDonald Heath
Published: April 2021

Predicting attendance at events is important for efficient facility management and marketing to maximize crowds. Most work to date is conducted at the aggregate level; however, the large crowd size being predicted often means important individual decisions are masked. In many markets, increased nonattendance by season ticket holders (STHs) is being reported, which is troubling given they have prepaid and are expected to be highly loyal. To understand who attends, rather than just how many, the authors analyze the “no-show” behavior of over 5,900 individual STH of one professional team over a season. Results show that in addition to game viewing and quality conditions, age, tenure, expenditure, and prior game attendance are predictors of individual attendance decisions, with differences in how individuals are influenced by winning and uncertainty of outcome. The paper expands understanding of drivers of STH attendance decisions and provides guidance toward managerial strategies for STH management.
Mechanisms of neuro-robotic prosthesis operation in leg amputees
Authors: Valle Giacomo , Saliji Albulena , Fogle Ezra , Cimolato Andrea , Petrini Francesco M. , Raspopovic Stanisa
Published: April 2021

Restoring neural sensory feedback to amputees improves the exploitation of leg prosthesis during motor tasks.
Cooperative evolution of polar distortion and nonpolar rotation of oxygen octahedra in oxide heterostructures
Authors: Min Taewon , Choi Wooseon , Seo Jinsol , Han Gyeongtak , Song Kyung , Ryu Sangwoo , Lee Hyungwoo , Lee Jungwoo , Eom Kitae , Eom Chang-Beom , Jeong Hu Young , Kim Young-Min , Lee Jaekwang , Oh Sang Ho
Published: April 2021

Oxide interface orientation tunes ferroelectric distortion and antiferrodistortive rotation into competition or cooperation.
Complete Genome Sequence of Carp Edema Virus Isolated from Koi Carp
Authors: Mekata Tohru , Kawato Yasuhiko , Ito Takafumi
Published: April 2021

Carp edema virus disease (CEVD), or koi sleepy disease, is caused by CEV. Here, we report the complete genome sequence of CEV strain FTI2020, isolated from koi carp. This sequence information has great potential for improving our understanding of the genetic characteristics of this piscine poxvirus.
Report of SARS-CoV-2 B1.1.7 Lineage in Morocco
Authors: Ouadghiri Mouna , Aanniz Tarik , Essabbar Abdelomunim , Seffar Myriam , Kabbaj Hakima , El Amin Ghizlane , Zouaki Amal , Amzazi Saaïd , Belyamani Lahcen , Ibrahimi Azeddine
Published: April 2021

Here, we report the near-complete genome sequence and the genetic variations of a clinical sample of SARS-CoV-2 harboring the N501Y mutation assigned to the B.1.1.7 lineage. The sample was collected from a nasopharyngeal swab of a female patient from Temara, Morocco, and the sequencing was done using Ion S5 technology.
Comparison of the efficacy and safety of cuffed versus uncuffed endotracheal tubes for infants in the intensive care setting: a pilot, unblinded RCT
Authors: Thomas Rebecca E , Erickson Simon , Hullett Bruce , Minutillo Corrado , Lethbridge Martyn , Vijayasekaran Shyan , Agrawal Sachin , Bulsara Max K , Rao Shripada C
Published: April 2021

Objective

To study effectiveness and safety of cuffed versus uncuffed endotracheal tubes (ETTs) in small infants in the intensive care unit (ICU).

Design

Pilot RCT.

Setting

Neonatal and paediatric ICUs of children’s hospital in Western Australia.

Participants

Seventy-six infants ≥35 weeks gestation and infants <3 months of age, ≥3 kg.

Interventions

Patients randomly assigned to Microcuff cuffed or Portex uncuffed ETT.

Main outcomes measures

Primary outcome was achievement of optimal ETT leak in target range (10%–20%). Secondary outcomes included: reintubations, ventilatory parameters, ventilatory complications, postextubation complications and long-term follow-up.

Results

Success rate (achievement of mean leak in the range 10%–20%) was 13/42 (30.9%) in the cuffed ETT group and 6/34 (17.6%) in uncuffed ETT group (OR=2.09; 95% CI (0.71 to 6.08); p=0.28). Mean percentage time within target leak range in cuffed ETT group 28% (IQR: 9–42) versus 15% (IQR: 0–28) in uncuffed ETT group (p=0.01). There were less reintubations to optimise size in cuffed ETT group 0/40 versus 10/36 (p<0.001). No differences were found in gaseous exchange, ventilator parameters or postextubation complications. There were fewer episodes of atelectasis in cuffed ETT group 0/42 versus 4/34 (p=0.03). No patient had been diagnosed with subglottic stenosis at long-term follow-up.

Conclusions

There was no difference in the primary outcome, though percentage time spent in optimal leak range was significantly higher in cuffed ETT group. Cuffed ETTs reduced reintubations to optimise ETT size and episodes of atelectasis. Cuffed ETTs may be a feasible alternative to uncuffed ETTs in this group of patients.

Trial registration number

ACTRN12615000081516.
Tale of two viruses: parvovirus B19 and HIV
Authors: Hernstadt Hayley , Randell Paul , Fidler Sarah , Foster Caroline
Published: April 2021

We present a HIV-infected patient who developed severe anaemia due to chronic parvovirus B19 infection and subsequently had an unplanned pregnancy. This is in the context of poor adherence to antiretroviral therapy and significant immunosuppression; there was a delay in diagnosis of chronic parvovirus infection due to attribution of anaemia to HIV. She received immunoglobulin therapy and effective antiretroviral therapy, with reduction in parvovirus load and improvement in anaemia. She was counselled regarding the need for monitoring in pregnancy due to risk of intrauterine infection. We review the literature of management of chronic parvovirus infection in the immunosuppressed and the consequences of intrauterine infection.
Plasmapheresis in lethal yellow phosphorus poisoning: a scope for recovery
Authors: Mathew Jithin , Gnanaraj John , Basavarajegowda Abhishekh , Venkateswaran Ramanathan
Published: April 2021

A 16-year-old girl presented with grade 3 hepatic encephalopathy (HE) following suicide attempt after consuming a lethal dose of yellow phosphorus containing rodenticide. Although she was a candidate for liver transplantation, it could not be done. In the absence of a specific antidote for yellow phosphorus poisoning, the patient was managed conservatively. In addition, low volume-therapeutic plasma exchange (LV-TPE) was initiated, which resulted in a dramatic improvement in HE. Although liver transplantation is the definitive treatment, this case has shown that TPE has a promising role as a ‘bridge to recovery’ in situations where transplantation is not feasible. We describe our experience with the above-mentioned case, along with the sequence of clinical recovery and the trend in biochemical parameters during follow-up. The patient made a full recovery and is doing well.
Peripheral thrombosis causing simultaneous saddle pulmonary embolism and paradoxical ST elevation myocardial infarction resulting in cardiovascular collapse
Authors: Ghafoor Hafiz , Sharma Nitish Kumar , Hashmath Zeba , Ramsaran Eddison
Published: April 2021

Paradoxical coronary artery embolism is often an underdiagnosed cause of acute myocardial infarction (MI). It should always be considered in patient with acute MI and a low risk profile for atherosclerotic coronary artery disease. We describe a patient with simultaneous acute saddle pulmonary embolism (PE) and acute ST segment elevation MI due to paradoxical coronary artery embolism. Transoesophageal echocardiography demonstrated a patent foramen ovale with right to left shunt and large saddle PE in the main pulmonary artery and coronary angiography demonstrated acute thrombotic occlusion of the right coronary artery.
Rare case of endogenous Klebsiella endophthalmitis associated with emphysematous prostatitis in a patient with diabetes, cirrhosis and COVID-19
Authors: Crane Alexander B , Abreu Diaz Monica C , Jiang Yi , Pergament Kathleen Mangunay
Published: April 2021

A 35-year-old Hispanic man presented with fever, chills, dysuria, diarrhoea, scleral icterus, tachycardia and tachypnea. He was found to be COVID-19 positive, CT of the pelvis revealed prostatic abscess, and urine culture grewKlebsiella pneumoniae. Additionally, he was found to have diabetes and cirrhosis. During treatment, the patient developed vision loss, and was diagnosed with endogenous Klebsiella endophthalmitis. The patient was treated with intravenous antibiotics, pars plana vitrectomy, intravitreal antibiotics and cystoscopy/suprapubic catheter placement. On follow-up, the patient has had the suprapubic catheter removed, and successfully passed a voiding trial, but suffers permanent vision loss in both eyes.
Calcified myocardial scar seen via cardiac imaging correlating with ventricular tachycardia focus
Authors: Zuzek Zachary , Rashid Imran , Cakulev Ivan , Josephson Richard A
Published: April 2021

A 74-year-old man presented with presyncope and non-sustained monomorphic ventricular tachycardia in the setting of acute coronary syndrome. On coronary angiogram, a calcified myocardial scar was revealed, which was later identified as the ventricular tachycardia focus via electrophysiological study.
Systemic acitretin in the management of periocular squamous cell carcinoma
Authors: Wang Haoyu , Bata Bashar , Currie Zanna , Salvi Sachin , Tan Jennifer
Published: April 2021

We report a case of periocular squamous cell carcinoma invading the anterior orbit that significantly reduced in size and regressed from invasive to in situ following treatment with oral acitretin, a second-generation retinoid. The residual in situ disease was then successfully treated with cryotherapy and the patient remains in remission 12 months following cessation of systemic acitretin.
Adult multisystem inflammatory syndrome in a patient who recovered from COVID-19 postvaccination
Authors: Uwaydah Ahmad Kanaan , Hassan Nidal M M , Abu Ghoush Mousa Suhail , Shahin Karim Mohamed Mohamed
Published: April 2021

Multisystem inflammatory syndrome in children has become a recognised syndrome, whereas a parallel syndrome in adults, multisystem inflammatory syndrome in adults (MIS-A), has not been well defined. Most cases occur several weeks following confirmed or suspected SARS-CoV-2 infection, but none have been reported in association with SARS-CoV-2 vaccines. Here we describe the case of a 22-year-old man, who received the inactivated SARS-CoV-2 vaccine 6 weeks following a mild COVID-19 infection. He presented after his second dose of the vaccine with a clinical picture of a multisystem inflammatory syndrome-like illness. Additionally, there was laboratory evidence of acute inflammation. The patient’s condition markedly improved after initiation of steroids. Whether the vaccine augmented an already-primed immunity from the infection and contributed to the occurrence of MIS-A is difficult to prove. Understanding the pathogenesis of this condition will shed light on this question and entail major implications on treatment and prevention.
Beyond HIV prevalence: identifying people living with HIV within underserved areas in South Africa
Authors: Kim Hana , Tanser Frank , Tomita Andrew , Vandormael Alain , Cuadros Diego F
Published: April 2021

Introduction

Despite progress towards the Joint United Nations Programme on HIV/AIDS 95-95-95 targets, South Africa is still suffering from one of the largest HIV epidemics globally. In this study, we generated high-resolution HIV prevalence maps and identified people living with HIV (PLHIV) in underserved areas to provide essential information for the optimal allocation of HIV-related services.

Methods

The data come from the South Africa Demographic and Health Survey conducted in 2016 and spatial variables from other published literature. We produced high-resolution maps of HIV prevalence and underserved areas, defined as a greater than 30 min travel time to the nearest healthcare facility. Using these maps and the population density, we mapped PLHIV and the PLHIV within underserved areas for 30, 60 and 120 min thresholds.

Results

There was substantial geographic variation in HIV prevalence, ranging from 1.4% to 24.2%, with a median of 11.5% for men, and from 2.1% to 48.1%, with a median of 20.6% for women. Gauteng province showed the highest density for both HIV prevalence and PLHIV. 80% of all areas in the country were identified as underserved areas (30 min threshold), which contained more than 16% and 20% of the total men and women living with HIV, respectively. KwaZulu-Natal province had the largest number of PLHIV in underserved areas (30 min threshold) and showed less than one healthcare facility per 1000 PLHIV.

Conclusion

Our study showed extensive spatial variation of HIV prevalence and significant numbers of PLHIV in underserved areas in South Africa. Moreover, we identified locations where HIV-related services need to be intensified to reach the ~1.5 million PLHIV in underserved areas, particularly in KwaZulu-Natal province, with less than one healthcare facility per 1000 PLHIV.
Age at entry to UK military service and long-term mental health
Authors: Bergman Beverly P , Mackay DF , Fear NT , Pell JP
Published: April 2021

Introduction

It has been suggested that ‘junior entry’ to the UK Armed Forces (prior to age 17.5 years) increases the risk of adverse mental health outcomes. We used data from a large cohort of veterans to examine long-term mental health outcomes in veterans by age at entry to the UK Armed Forces, compared with non-veterans.

Methods

Retrospective cohort study of 78 157 veterans in Scotland, born between 1945 and 1995 and and 252 637 matched non-veterans, with up to 37 years follow-up, using Cox proportional hazard models to examine the association between veteran status and cumulative risk of major mental health disorder, stratified by birth cohort, and age at recruitment for the veterans.

Results

The risk of mental health disorder in the veterans increased with age at entry, ranging from HR 1.12, 95% CI 1.06 to 1.18, p<0.001 for junior entrants to HR 1.37, 95% CI 1.27 to 1.80, p<0.001 for those aged 20–25 years at entry. The pattern was most marked for veterans born before 1960, and age at recruitment had little impact in recent birth cohorts. Post-traumatic stress disorder accounted for most of the observed differences. Younger age at recruitment was associated with longer service, median 7.4 years (IQR 3.0–14.7) compared with 5.6 years (IQR 2.1–11.7) for entrants aged 20–25 years.

Conclusion

We found no evidence that early recruitment is associated with adverse impact on long-term mental health. Paradoxically, it was veterans who entered service at age 20–25 years who demonstrated increased risk, although this attenuated in more recent birth cohorts.
Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants?
Authors: Jones Margaret , Jones N , Burdett H , Bergman B P , Fear N T , Wessely S , Rona R J
Published: April 2021

Introduction

The UK is the only permanent member of the UN Security Council that has a policy of recruiting 16 and 17 year old individuals into its regular Armed Forces. Little is known about the consequences of enlisting as a Junior Entrant (JE), although concerns have been expressed. We compare the mental health, deployment history, and pre-enlistment and post-enlistment experiences of personnel who had enlisted as JEs with personnel who joined as Standard Entrants (SEs).

Method

Participants from a large UK military cohort study completed a self-report questionnaire between 2014 and 2016 that included symptoms of probable post-traumatic stress disorder (PTSD), common mental disorders, alcohol consumption, physical symptoms and lifetime self-harm. Data from regular non-officer participants (n=4447) from all service branches were used in the analysis. JEs were defined as having enlisted before the age of 17.5 years. A subgroup analysis of participants who had joined or commenced adult service after April 2003 was carried out.

Results

JEs were not more likely to deploy to Iraq or Afghanistan but were more likely to hold a combat role when they did (OR 1.25, 95% CI 1.00 to 1.56). There was no evidence of an increase in symptoms of common mental disorders, PTSD, multiple somatic symptoms (MSS), alcohol misuse or self-harm in JEs in the full sample, but there was an increase in alcohol misuse (OR 1.84, 95% CI 1.18 to 2.87), MSS (OR 1.51, 95% CI 1.04 to 2.20) and self-harm (OR 2.13, 95% CI 1.15 to 3.95) in JEs who had commenced adult service after April 2003. JEs remain in adult service for longer and do not have more difficulties when they leave service.

Conclusions

JEs do not have worse mental health than SEs, but there is uncertainty in relation to alcohol misuse, MSS and self-harm in more recent joiners. Monitoring these concerns is advisable.
Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study
Authors: Irving Jessica , Colling Craig , Shetty Hitesh , Pritchard Megan , Stewart Robert , Fusar-Poli Paolo , McGuire Philip , Patel Rashmi
Published: April 2021

Objective

To determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs).

Design, setting and participants

Data were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms.

Exposure(s) (for observational studies)

Gender (male vs female).

Main outcome(s) and measure(s)

Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation.

Results

Eight symptoms were significantly more prevalent in men (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation). Conversely, tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation were more prevalent in women than men. Negative symptoms were more common among men (OR 1.85, 95% CI 1.33 to 2.62) and depressive and manic symptoms more common among women (OR 0.30, 95% CI 0.26 to 0.35). After adjustment for illicit substance use, the strength of associations between gender and negative, manic and depression symptoms increased, whereas gender differences in aggression, agitation, paranoia and grandiosity became insignificant.

Conclusions

There are clear gender differences in the clinical presentation of FEP. Our findings suggest that gender can have a substantial influence on the nature of clinical presentation in people with psychosis, and that this is only partly explained by exposure to illicit substance use.
Measuring perceived adequacy of staffing to incorporate nurses’ judgement into hospital capacity management: a scoping review
Authors: van der Mark Carmen J E M , Vermeulen Hester , Hendriks Paul H J , Oostveen Catharina J van
Published: April 2021

Background

Matching demand and supply in nursing work continues to generate debate. Current approaches focus on objective measures, such as nurses per occupied bed or patient classification. However, staff numbers do not tell the whole staffing story. The subjective measure of nurses’ perceived adequacy of staffing (PAS) has the potential to enhance nurse staffing methods in a way that goes beyond traditional workload measurement or workforce planning methods.

Objectives

To detect outcomes associated with nurses’ PAS and the factors that influence PAS and to review the psychometric properties of instruments used to measure PAS in a hospital setting.

Design and methods

A scoping review was performed to identify outcomes associated with PAS, factors influencing PAS and instruments measuring PAS. A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Business Source Complete and Embase databases identified 2609 potentially relevant articles. Data were independently extracted, analysed and synthesised. The quality of studies describing influencing factors or outcomes of PAS and psychometric properties of instruments measuring PAS were assessed following the National Institute for Health and Care Excellence quality appraisal checklist and the COnsensus-based Standards for the selection of health Measurement INstruments guidelines.

Results

Sixty-three studies were included, describing 60 outcomes of PAS, 79 factors influencing PAS and 21 instruments measuring PAS. In general, positive PAS was related to positive outcomes for the patient, nurse and organisation, supporting the relevance of PAS as a staffing measure. We identified a variety of factors that influence PAS, including demand for care, nurse supply and organisation of care delivery. Associations between these factors and PAS were inconsistent. The quality of studies investigating the development and evaluation of instruments measuring PAS was moderate.

Conclusions

Measuring the PAS may enhance nurse staffing methods in a hospital setting. Further work is needed to refine and psychometrically evaluate instruments for measuring PAS.
Role of masks, testing and contact tracing in preventing COVID-19 resurgences: a case study from New South Wales, Australia
Authors: Stuart Robyn M , Abeysuriya Romesh G , Kerr Cliff C , Mistry Dina , Klein Dan J , Gray Richard T , Hellard Margaret , Scott Nick
Published: April 2021

Objectives

The early stages of the COVID-19 pandemic illustrated that SARS-CoV-2, the virus that causes the disease, has the potential to spread exponentially. Therefore, as long as a substantial proportion of the population remains susceptible to infection, the potential for new epidemic waves persists even in settings with low numbers of active COVID-19 infections, unless sufficient countermeasures are in place. We aim to quantify vulnerability to resurgences in COVID-19 transmission under variations in the levels of testing, tracing and mask usage.

Setting

The Australian state of New South Wales (NSW), a setting with prolonged low transmission, high mobility, non-universal mask usage and a well-functioning test-and-trace system.

Participants

None (simulation study).

Results

We find that the relative impact of masks is greatest when testing and tracing rates are lower and vice versa. Scenarios with very high testing rates (90% of people with symptoms, plus 90% of people with a known history of contact with a confirmed case) were estimated to lead to a robustly controlled epidemic. However, across comparable levels of mask uptake and contact tracing, the number of infections over this period was projected to be 2–3 times higher if the testing rate was 80% instead of 90%, 8–12 times higher if the testing rate was 65% or 30–50 times higher with a 50% testing rate. In reality, NSW diagnosed 254 locally acquired cases over this period, an outcome that had a moderate probability in the model (10%–18%) assuming low mask uptake (0%–25%), even in the presence of extremely high testing (90%) and near-perfect community contact tracing (75%–100%), and a considerably higher probability if testing or tracing were at lower levels.

Conclusions

Our work suggests that testing, tracing and masks can all be effective means of controlling transmission. A multifaceted strategy that combines all three, alongside continued hygiene and distancing protocols, is likely to be the most robust means of controlling transmission of SARS-CoV-2.
Conducting an ongoing HIV clinical trial during the COVID-19 pandemic in Uganda: a qualitative study of research team and participants’ experiences and lessons learnt
Authors: Muwanguzi Patience A , Kutyabami Paul , Osingada Charles Peter , Nasuuna Esther M , Kitutu Freddy Eric , Ngabirano Tom Denis , Nankumbi Joyce , Muhindo Richard , Kabiri Lydia , Namutebi Mariam , Nabunya Racheal , Kiwanuka Noah , Sewankambo Nelson
Published: April 2021

Objective

To explore the experiences and lessons learnt by the study team and participants of the Workplace-based HIV self-testing among Men trial during the COVID-19 pandemic in Uganda.

Design

An explorative qualitative study comprising two virtual focus group discussions (FGDs) with 12 trial team members and 32 in-depth participant interviews (N=44). Data were collected via telephone calls for in-depth interviews or Zoom for FGDs and manually analysed by inductive content analysis.

Setting

Fourteen private security companies in two Uganda districts.

Participants

Members of the clinical trial study team, and men working in private security companies who undertook workplace-based HIV testing.

Results

The key themes for participants experiences were: ‘challenges in accessing HIV treatment and care, and prevention services’, ‘misinformation’ and ‘difficulty participating in research activities’. The effects on HIV treatment and prevention resulted from; repercussions of the COVID-19 restrictions, participants fear of coinfection and negative experiences at health facilities. The difficulty in participating in research activities arose from: fear of infection with COVID-19 for the participants who tested HIV negative, transport difficulties, limited post-test psychosocial support and lack of support to initiate pre-exposure prophylaxis. The key study team reflections focused on the management of the clinical trial, effects of the local regulations and government policies and the need to adhere to ethical principles of research.

Conclusions

Findings highlight the need to organise different forms of HIV support for persons living with HIV during a pandemic. Additionally, the national research regulators and ethics committees or review boards are strongly urged to develop policies and guidelines for the continuity of research and clinical trials in the event of future shocks. Furthermore, this study calls on the appropriate government agencies to ensure public and researchers’ preparedness through continuing education and support.

Trial registration number

Clinicaltrials.gov NCT04164433; Pre-results.
Protocol for The Toxin Study: Understanding clinical and patient reported response of children and young people with cerebral palsy to intramuscular lower limb Botulinum neurotoxin-A injections, exploring all domains of the ICF. A pragmatic longitudinal observational study using a prospective one-group repeated measures design
Authors: Katchburian Lesley R , Oulton Kate , Main Eleanor , Morris Christopher , Carr Lucinda J
Published: April 2021

Introduction

Botulinum neurotoxin-A (BoNT-A) is an accepted treatment modality for the management of hypertonia in children and young people with cerebral palsy (CYPwCP). Nevertheless, there are concerns about the long-term effects of BoNT-A, with a lack of consensus regarding the most meaningful outcome measures to guide its use. Most evidence to date is based on short-term outcomes, related to changes at impairment level (restrictions of body functions and structures), rather than changes in adaptive skills (enabling both activity and participation). The proposed study aims to evaluate clinical and patient reported outcomes in ambulant CYPwCP receiving lower limb BoNT-A injections over a 12-month period within all domains of the WHO’s International Classification of Functioning, Disability and Health and health-related quality of life (HRQoL).

Methods and analysis

This pragmatic prospective longitudinal observational study will use a one-group repeated measures design. Sixty CYPwCP, classified as Gross Motor Function Classification System (GMFCS) levels I–III, aged between 4 and 18 years, will be recruited from an established movement disorder service in London, UK. Standardised clinical and patient reported outcome measures within all ICF domains; body structures and function, activity (including quality of movement), goal attainment, participation and HRQoL, will be collected preinjection and at 6 weeks, 6 months and up to 12 months postinjection. A representative subgroup of children and carers will participate in a qualitative component of the study, exploring how their experience of BoNT-A treatment relates to clinical outcome measures.

Ethics and dissemination

Central London Research Ethics Committee has granted ethics approval (#IRAS 211617 #REC 17/LO/0579). Findings will be disseminated in peer-reviewed publications, conferences and via networks to participants and relevant stakeholders using a variety of accessible formats including social media.
BET 1: Do homemade or cloth face masks work as a preventive measure for respiratory virus transmission?
Authors: Delvaux Nicolas , Aertgeerts Bert , Verbakel Jan Yvan Jos
Published: April 2021

A short-cut review of the available medical literature was carried out to establish whether homemade or cloth face masks can prevent respiratory virus transmission or clinical illness. After abstract review, twelve papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is currently no direct evidence to support the use of homemade or cloth masks by the general public for protection against viral infections.
Emergency department management of older people living with frailty: a guide for emergency practitioners
Authors: Hogervorst Vera M , Buurman Bianca M , De Jonghe Annemarieke , van Oppen James David , Nickel Christian Hans , Lucke Jacinta , Blomaard Laura C , Thaur Arjun , Mooijaart Simon P , Banerjee Jay , Wallace James , de Groot Bas , Conroy Simon Paul
Published: April 2021

Emergency Departments (EDs) are increasingly seeing more seriously unwell older people living with frailty. In the context of limited resources and increasing demand it’s the ED practitioner’s challenge to unpick this constellation of physical, psychological, functional and social issues.To properly assess older people living with frailty at the ED it is crucial to use an holistic approach. This consists of triage with algorithms sensitive to the higher risk of older people living with frailty, a frailty assessment, and an assessment with the help of the principles of Comprehensive Geriatric Assessment. Multi-disciplinary care, a tailor-made treatment plan, based on what the person values most, will help the ED practitioner to deliver appropriate and valuable care during the ED stay, but also in transition from hospital to home.
Diagnosis of coeliac disease by flow cytometry of intraepithelial lymphocytes: a new ‘gold’ standard?
Authors: Basu Kaninika , Creasey Hannah , Bruggemann Nina , Stevens Jennifer , Bloxham David , Woodward Jeremy Mark
Published: April 2021

Objective

The analysis of intraepithelial lymphocytes (IELs) by flow cytometry of duodenal biopsies—the ‘IEL’ lymphogram—has been proposed as a diagnostic test for coeliac disease. However, its clinical applicability has been limited due to variability in methods and definitions. This study set out to define useful parameters for the application of the IEL lymphogram to the diagnosis of coeliac disease.

Design

Flow cytometry was performed on 117 sets of duodenal biopsies in 107 adult patients with active coeliac disease, long-term coeliac disease on a gluten free diet and a control group. The initial 95 samples were used for hypothesis generation for the subsequent samples comprising 12 patients with coeliac disease and 10 controls.

Results

Rather than using single linear cut-offs for CD3 and T-cell receptor γδ (TCRγδ)+ve IELs, a discriminant function was identified as %CD3+ve IELs+2x(%TCRγδ+IELs)>100. This differentiated coeliac disease from control biopsies in the hypothesis generating group. These results were replicated in the validation group and found to be independent of histology in patients on long-term gluten free diet up to 12 years (combined sensitivity, 98.5%; specificity, 97.7%).

Conclusions

Flow cytometric analysis of IELs is a highly sensitive and specific adjunct to serology and histological examination for the diagnosis of coeliac disease, even in individuals with coeliac disease following a gluten free diet who exhibit normal duodenal histology.
Personalised virtual gene panels reduce interpretation workload and maintain diagnostic rates of proband-only clinical exome sequencing for rare disorders
Authors: Molina-Ramírez Leslie Patricia , Kyle Claire , Ellingford Jamie M , Wright Ronnie , Taylor Algy , Bhaskar Sanjeev S , Campbell Christopher , Jackson Harriet , Fairclough Adele , Rousseau Abigail , Burghel George J , Dutton Laura , Banka Siddharth , Briggs Tracy A , Clayton-Smith Jill , Douzgou Sofia , Jones Elizabeth A , Kingston Helen M , Kerr Bronwyn , Ealing John , Somarathi Suresh , Chandler Kate E , Stuart Helen M , Burkitt-Wright Emma MM , Newman William G , Bruce Iain A , Black Graeme C , Gokhale David
Published: April 2021

Purpose

The increased adoption of genomic strategies in the clinic makes it imperative for diagnostic laboratories to improve the efficiency of variant interpretation. Clinical exome sequencing (CES) is becoming a valuable diagnostic tool, capable of meeting the diagnostic demand imposed by the vast array of different rare monogenic disorders. We have assessed a clinician-led and phenotype-based approach for virtual gene panel generation for analysis of targeted CES in patients with rare disease in a single institution.

Methods

Retrospective survey of 400 consecutive cases presumed by clinicians to have rare monogenic disorders, referred on singleton basis for targeted CES. We evaluated diagnostic yield and variant workload to characterise the usefulness of a clinician-led approach for generation of virtual gene panels that can incorporate up to three different phenotype-driven gene selection methods.

Results

Abnormalities of the nervous system (54.5%), including intellectual disability, head and neck (19%), skeletal system (16%), ear (15%) and eye (15%) were the most common clinical features reported in referrals. Combined phenotype-driven strategies for virtual gene panel generation were used in 57% of cases. On average, 7.3 variants (median=5) per case were retained for clinical interpretation. The overall diagnostic rate of proband-only CES using personalised phenotype-driven virtual gene panels was 24%.

Conclusions

Our results show that personalised virtual gene panels are a cost-effective approach for variant analysis of CES, maintaining diagnostic yield and optimising the use of resources for clinical genomic sequencing in the clinic.
Environmental racialisation and poetics of influence in the postgenomic era: fire, soil, spirit
Authors: Choksey Lara
Published: April 2021

This article considers processes of environmental racialisation in the postgenomic era through their politics of difference and poetics of influence. Subfields like epigenetics promise to account for a plurality of possible influences on health outcomes. While this appears to present possibilities for historical reparation to communities whose epigenomes may have been chronically altered by histories of violence and trauma, the prevailing trend has been to compound processes of racialisation in the reproduction of good/bad environments. The postgenomic era has promised an epistemological transformation of ideas and values of human life, but its practices, technologies and ideology have so far prevented this. Epigenetics, rather, reproduces biomedical exclusions through imaginaries of embodied contexts, methods of occlusion and hypervisibility, and assignations of delay and deviance. This is more complex than both genetic reductionism and environmental racism: studies on epigenetics reveal a poetics of influence at work under liberal humanism complicit in the creation of death-worlds for racialised populations. Other experiments with life are possible and unfolding: Jay Bernard’s poem ‘Chemical’, set in the aftermath of London’s Grenfell Tower fire in 2017, unmoors its bodies from material environment, offering a spectral configuration of collective life. This configuration involves negotiating with the fixing of time and space on which genomic imaginaries depend.
Randomised study of PF-06410293, an adalimumab (ADL) biosimilar, compared with reference ADL for the treatment of active rheumatoid arthritis: results from weeks 26–52, including a treatment switch from reference ADL to PF-06410293
Authors: Fleischmann Roy M , Alvarez Daniel F , Bock Amy E , Cronenberger Carol , Vranic Ivana , Zhang Wuyan , Alten Rieke
Published: April 2021

Objective

To investigate the efficacy, safety, immunogenicity and pharmacokinetics of biosimilar adalimumab (ADL) PF-06410293 (ADL-PF; adalimumab-afzb) versus EU-sourced reference ADL (ADL-EU) in patients with active rheumatoid arthritis (RA) on longer-term treatment and after being switched from ADL-EU to ADL-PF.

Methods

In this multinational, double-blind study, patients with active RA were initially randomised to ADL-PF or ADL-EU for 26 weeks (treatment period (TP) 1). At the start of TP2 (weeks 26–52), patients in the ADL-EU arm were blindly re-randomised 1:1 to remain on ADL-EU (ADL-EU/ADL-EU; n=135) or switched to ADL-PF (ADL-EU/ADL-PF; n=134); patients receiving ADL-PF continued blinded treatment (ADL-PF/ADL-PF; n=283).

Results

The American College of Rheumatology 20% improvement (ACR20) response rates were comparable between treatment groups at all visits during TP2. At week 52, ACR20 response rates were 82.7% (ADL-PF/ADL-PF), 79.3% (ADL-EU/ADL-EU) and 84.3% (ADL-EU/ADL-PF). Other measures of deep response (ACR50/70, ACR/EULAR-defined remission, EULAR good response, and Disease Activity Score in 28 Joints Based on High-Sensitivity C-Reactive Protein <2.6) and Health Assessment Questionnaire−Disability Index were maintained over TP2 and comparable between groups. Treatment-emergent adverse events were reported in 43.5% (ADL-PF/ADL-PF), 44.4% (ADL-EU/ADL-EU) and 38.3% (ADL-EU/ADL-PF) of patients; there were no clinically meaningful differences in the safety profiles between groups. The percentage of patients who were antidrug antibody positive was comparable overall among ADL-PF/ADL-PF (47.3%), ADL-EU/ADL-EU (54.1%) and ADL-EU/ADL-PF (45.9%).

Conclusions

The similar efficacy, safety, immunogenicity and pharmacokinetics of ADL-PF and ADL-EU, maintained up to week 52, were unaffected by blinded treatment switch from ADL-EU to ADL-PF at week 26.

Trial registration number

ClinicalTrials.gov identifier:NCT02480153; EudraCT number: 2014-000352-29.