bluuebunny/crossref_metadata_2025 huggingface dataset:
The combined role of clinical, reflectance confocal microscopy and dermoscopy applied to chronic discoid cutaneous lupus and subacutus lupus erythematosus: A case series and literature review
Authors: Mazzilli Sara , Vollono Laura , Diluvio Laura , Botti Elisabetta , Costanza Gaetana , Campione Elena , Donati Michele , Prete Monia di , Orlandi Augusto , Bianchi Luca , Gonzalez Salvador
Published: October 2020

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 μm, vertical ∼5 μm), en face tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.
Proton magnetic resonance spectroscopy (1H-MRS) in rheumatic autoimmune diseases: A systematic review
Authors: Frittoli Renan Bazuco , Pereira Danilo Rodrigues , Rittner Leticia , Appenzeller Simone
Published: October 2020

Background/Purpose

Proton magnetic resonance spectroscopy (1H-MRS) has been shown to be an important non-invasive tool to quantify neuronal loss or damage in the investigation of central nervous system (CNS) disorders. The purpose of this article is to discuss the clinical utility of 1H-MRS in determining CNS involvement in individuals with rheumatic autoimmune diseases.

Methods

This study is a systematic review of the literature, conducted during the month of November and December of 2019 of articles published in the last 16 years (2003-2019). The search for relevant references was done through the exploration of electronic databases (PubMed/Medline and Embase). We searched for studied including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), juvenile idiopathic arthritis, rheumatoid arthritis (RA), psoriasis, Sjögren's syndrome (pSS), vasculitis and Behçet. Only studies published after 2003 and with more than 20 patients were included.

Results

We included 26 articles. NAA/Cr ratios were significant lower and Cho/Cr ratios increased in several brain regions in SLE, SS, RA, SSc. Associations with disease activity, inflammatory markers, CNS manifestations and comorbidities was variable across studies and diseases.

Conclusion

The presence of neurometabolite abnormalities in patients without ouvert CNS manifestations, suggests that systemic inflammation, atherosclerosis or abnormal vascular reactivity may be associated with subclinical CNS manifestations. MRS may be a usefull non-invasive method for screening patients with risk for CNS manifestations.
Prediction of cancer survival for cohorts of patients most recently diagnosed using multi-model inference
Authors: Maringe Camille , Belot Aurélien , Rachet Bernard
Published: October 2020

Despite a large choice of models, functional forms and types of effects, the selection of excess hazard models for prediction of population cancer survival is not widespread in the literature. We propose multi-model inference based on excess hazard model(s) selected using Akaike information criteria or Bayesian information criteria for prediction and projection of cancer survival. We evaluate the properties of this approach using empirical data of patients diagnosed with breast, colon or lung cancer in 1990–2011. We artificially censor the data on 31 December 2010 and predict five-year survival for the 2010 and 2011 cohorts. We compare these predictions to the observed five-year cohort estimates of cancer survival and contrast them to predictions from an a priori selected simple model, and from the period approach. We illustrate the approach by replicating it for cohorts of patients for which stage at diagnosis and other important prognosis factors are available. We find that model-averaged predictions and projections of survival have close to minimal differences with the Pohar-Perme estimation of survival in many instances, particularly in subgroups of the population. Advantages of information-criterion based model selection include (i) transparent model-building strategy, (ii) accounting for model selection uncertainty, (iii) no a priori assumption for effects, and (iv) projections for patients outside of the sample.
Escape the Womb: A Maternal Emergency
Authors: Hardie Lori , Gill Amanda , Lee Stephanie , Shiveley Jody
Published: October 2020

Background.

Due to advanced maternal age, obesity, drug use, and other comorbidities, the frequency of maternal cardiac arrest continues to rise nationally and in our Midwestern community hospital. While still a relatively rare occurrence, the national rise in maternal mortality rates has created a need for population-specific resuscitation education for caregivers of obstetric patients. Educators are challenged with creating engaging, meaningful education that is inexpensive and effective. Educational escape rooms challenge participants to discover clues, solve puzzles, progress through the game and ultimately escape the room. The format offers team problem-solving and experiential learning with immediate feedback in an enjoyable atmosphere.

Aim.

In order to provide an interprofessional and economical educational intervention for labor and delivery teams, the authors created an escape room focused on principles of effective maternal resuscitation.

Method.

Participants completed an evaluation tool measuring perceptions of content clarity and confidence, and an author created pre-test and post-test to measure knowledge of cardiopulmonary resuscitation medications and interventions for the obstetric patient.

Results and Conclusions.

Comparison of aggregated pre- and post-test showed an 11% increase in knowledge scores. All participants self-evaluation showed improved clarity and confidence and described the activity as a fun way to learn and reinforce knowledge.
Emergency-Only Hemodialysis Policies
Authors: Lavingia Richa , Raghavan Rajeev , Morain Stephanie R.
Published: October 2020

An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. ‘Emergency-only hemodialysis’ (EOHD) is associated with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable longterm solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD.
Empirical Investigation of Ethical Challenges Related to the Use of Biological Therapies
Authors: Bladt Tara , Vorup-Jensen Thomas , Sædder Eva , Ebbesen Mette
Published: October 2020

The aim of this study was to investigate the ethical dilemma of prioritising financial resources to expensive biological therapies. For this purpose, the four principles of biomedical ethics formulated by ethicists Tom Beauchamp and James Childress were used as a theoretical framework. Based on arguments of justice, Beauchamp and Childress advocate for a health care system organised in line with the Danish system. Notably, our study was carried out in a Danish setting.
Assessment of patients’ understanding of and adherence to oral anticancer medication (OAM): Results of a cross-sectional institutional pilot study
Authors: Rodday Angie Mae , Hackenyos Douglas , Masood Raisa , Savidge Nicole , Lin Mingqian , Weidner Ruth Ann , Parsons Susan K
Published: October 2020

Background

Although oral anticancer medications (OAM) provide opportunity for treatment at home, challenges include prescription filling, monitoring side effects, safe handling, and adherence. We assessed understanding of and adherence to OAM in vulnerable patients.

Methods

This 2018 pilot study defined vulnerable patients based on Chinese language, older age (≥65 years), and subsidized insurance. All participants had a cancer diagnosis and were taking an OAM filled through the hospital’s specialty pharmacy. Participants reported on OAM taking (days per week, times per day, special instructions) and handling (handling, storage, disposal). The specialty pharmacist classified patient-reported responses about OAM taking and handling as adequate or inadequate. OAM regimens were classified by complexity.

Results

Of 61 eligible patients, 55 participated. Mean age was 68 years (standard deviation [SD] = 12) and 53% were female. Patient subgroups were: 27% Chinese, 64% ≥65 years, and 9% subsidized insurance. Forty-nine percent were on frontline therapy and median time on OAM was 1 year (Quartile 1 = 0.4, Quartile 3 = 1.7). Adequacy of OAM taking (30%) and handling (15%) were low; 15% had adequacy in both. Adequacy of OAM taking and handling did not vary by patient subgroup or regimen complexity. Mean patient-reported adherence was high (5.4, SD = 1, possible range 1–6) and did not vary by adequacy of OAM taking or handling.

Conclusions

Understanding of OAM taking and handling in this group of vulnerable patients was low and did not align with patient-reported adherence. Future interventions should ensure that patients understand how to safely take and handle OAM, thereby optimizing their therapeutic potential.
Assessment of Canadian patient education material for oncology pharmaceutics
Authors: van Ballegooie Courtney
Published: October 2020

Introduction

Health literacy is an individual’s ability to access, understand, and utilize information in order to create an informed decision regarding their health. Readability plays an integral role in health literacy as complex health information may be inaccessible to those with low health literacy. The aim of this study is to determine the readability of Canadian patient education material (PEM) for oncology related pharmaceutics.

Methods

Eighty PEMs from Cancer Care Ontario (CCO) and BC Cancer (BCC) were evaluated for their reading level using a Ford, Caylor, Sticht (FORCAST) analysis. Twenty therapies were then randomly selected and converted to plain text to be analyzed further using the Flesch-Kincaid Grade Level (FKGL), the Simple Measure of Gobbledygook (SMOG) Index, the Coleman-Liau Index (CLI), and the Gunning Fog Index (GFI).

Results

Both PEMs from CCO and BCC were above the recommended reading level with PEMs from CCO, on average, requiring a higher reading level. Within the text, the section which describes side effects was found to be the most complex section of the representative PEMs from BCC. PEMs from BCC which described antibody-based therapies were, on average, more difficult to read than small molecule-based therapies regardless from which section the PEM was being analyzed. These observations were not seen in CCO PEMs.

Conclusions

Overall, online PEMs from major Canadian cancers associations were written above the recommended reading level. Consideration should be given to revision of these materials, with emphasis on the therapies’ side effects, to allow for greater comprehension amongst a wider target audience.
The tribological properties of porous cotton/phenolic bearing retainer on different surfaces
Authors: Zhang Yafeng , Zhang Shaohua , Zhou Gang , Zhang Jiyang , Qing Tao , Zhou Ningning
Published: October 2020

Porous cotton/phenolic resin has been widely made into bearing retainer because of its excellent good dimensional stability and self-lubricating functions. In this paper, the frictional anisotropy of porous cotton/phenolic bearing retainer on different surfaces were studied using a friction and wear testing machine. Results showed that the friction coefficient on the guiding surface of the retainer was higher than that on the ending surface. However, wear volumes on the guiding surface was lower than that on the ending surface. For the ending surface, the wear volumes in the direction perpendicular to cotton fiber were higher than that parallel to cotton fiber. Based on the experiments, a wear model was proposed to illustrate the frictional anisotropy of the retainer. Analysis indicated that the wear rate was inversely proportional to the square of elastic modulus. The ratio of wear rate obtained from the model was in good agreement with the experimental results. The findings can be used to explain the wear difference of the retainer on different surfaces during operation. Besides, the model has potential applications in the design of bearing composite materials to improve its anti-wear behaviors.
It’s complicated: Sex and the BDSM subculture
Authors: Fennell Julie
Published: October 2020

Drawing from extensive insider ethnographic work and an internet survey with a convenience sample of 1642 BDSM practitioners, I show that the social context of the BDSM subculture has a profound impact on pansexual BDSM practitioners’ interpretation of the relationship between BDSM and sex. Greater involvement in the public BDSM subculture and participation in feminine Dominance/masculine submission are both strongly associated with less preference for and experience of sexual BDSM. Greater involvement in the BDSM subculture increases participants’ likelihood of viewing their sexuality in terms of BDSM but decreases their likelihood of viewing BDSM in sexual terms. BDSM practitioners who meet new BDSM partners in BDSM subcultural contexts, even ones where sex is allowed, are much less likely to have sex with their partners than practitioners who met anywhere else. I argue that research should focus more on the social factors that influence participants’ experience and interpretation of BDSM, particularly on the influence of the BDSM subculture, and that theorists should think more broadly about the social determinants of “sex” and “sexual experience.”
Experimental investigation of spring-back phenomenon through an L-die bending process for multilayered sheets produced by the accumulative press bonding technique
Authors: Etemadi E , Rahmatabadi D , Hosseini SM , Hashemi R
Published: October 2020

For the first time in this study, the accumulative press bonding method was used to fabricate layer composites, including ceramic powder and metallic layers, and the spring-back as a functional plasticity test experimentally investigated. Al/Cu and Al/Cu/Al2O3 composites were successfully manufactured in five accumulative press bonding cycles, and in addition to spring-back evaluation, mechanical properties and plastic instability were investigated. The results showed that by the end of the third cycle, both composites were fully layered structure. However, in the fifth cycle in the Al/Cu/Al2O3 composite, plastic instability intensified and necking and fracture at all Cu layers observed due to the presence of particles in the interface and further differences in mechanical properties. As the number of accumulative press bonding cycles increases, the number of Al/Cu interfaces, which are the places where the reinforcement particles are dispersed, increases, thereby significantly improving the particle distribution and mechanical properties. The mechanical properties were improved by increasing the applied strain to the two composites, mainly due to the mechanisms underlying the severe plastic deformation processes, including cold working and microstructure improvement. The mechanical properties of the composite containing reinforcing particles improved the tensile strength and microhardness of both layers in all accumulative press bonding cycles, although the amount of elongation decreased slightly. The maximum tensile strength values of the two composites were obtained at the end of the fifth cycle, which improved the tensile strength for Al/Cu and Al/Cu/Al2O3 by about 2.65 and 2.42 times higher than unprocessed Al matrix, respectively. Experimental results of the spring-back evaluation showed that the composite with reinforcement powder due to the higher Young’s modulus had lower spring-back value. The amount of spring-back in both composites decreased with almost the same rate as the applied strain increased.
Does the UK ‘citizenship process’ lead immigrants to reject British identity? A panel data analysis
Authors: Bartram David
Published: October 2020

In societies where solidarity and cohesion are experienced primarily via shared national identity, immigration raises questions regarding how non-nationals can gain social membership, so that they are not perceived as undermining solidarity and cohesion. A key aspect of immigrants’ experiences is thus whether they embrace the national identity of the destination country. Governments in many destination countries increasingly seek to ensure that they do, via policy initiatives that impose specific requirements for gaining legal citizenship: applicants for naturalization are commonly required to pass a test (ensuring sufficient knowledge of e.g. ‘life in the UK’) and attend a ceremony that includes a pledge of loyalty. This paper considers whether the British version of these requirements is effective in leading immigrants to embrace British national identity. It uses data drawn from the UK household panel survey (‘Understanding Society’) to facilitate a comparison between those immigrants who become citizens and those who do not. The main finding is that those who become citizens significantly increase their attachment to British identity. Whether they do so specifically because of the policy requirements (the test and ceremony) is debatable, but it seems clear that these requirements do not inhibit development of a sense of Britishness among the immigrants who meet them.
What can the sociology of race learn from the histories of anti-colonialism?
Authors: Meghji Ali
Published: October 2020

This essay looks at three books on the histories of anti-colonialism: Desai’s the United States of India, Getachew’s Worldmaking after Empire, and Gopal’s Insurgent Empire. I argue that despite it not being the authors’ primary focus, these books collectively push forward the sociology of race. In particular, each of these books shows the importance for contemporary race and racism scholarship to adopt a transnational, temporally connected approach which is able to both study and forge global anti-colonial solidarities.
Gravity wave interaction with multiple submerged artificial reefs
Authors: Vijay KG , Neelamani S , Nishad CS , Sahoo T
Published: October 2020

In the present study, gravity wave interaction with a series of submerged artificial permeable reefs is analysed within the framework of linearised water wave theory. For wave past porous walls of the artificial reefs, a quadratic pressure drop is assumed to account for the wave energy dissipation due to the changes in wave height. The physical problem is handled for a solution using a numerical model based on the iterative multi-domain boundary element method and the developed numerical model is validated with known results in the literature. The iterative model is compared with the numerical model based on linear pressure drop boundary condition (i.e., Darcy law). The study reveals that the wave transmission reduces with the increase in the number of reef units. It is demonstrated that the transmission coefficient can be reduced to less than 0.5 when the number of reef units is greater than or equal to three for a relative height greater than 0.7, reef porosities less than 20% and for 0.4<k0h<3.0. Bragg reflection is observed when the porosity is in the range of 0 to 10% and above which the recurrent nature of wave reflection gradually fades away due to dissipation effects. The number of peaks occurring in the shallow and intermediate water depths is equal to the number of reef units wherein the maxima occur at the first frequency. A relative increase in the base width improves the energy losses but the rate of increase in energy loss decreases. The scattering coefficient pattern is oscillatory when the relative spacing between the barriers is varied and their hydrodynamic performance is invariant for higher relative base width.
Learning From a Failed Mixed Methods Child Art-Therapy Research Project
Authors: Ciuhan Geanina Cucu , Iliescu Dragos
Published: October 2020

This paper critically describes a mixed methods study focused on the development of a measurement instrument and the effectiveness evaluation of an art-therapy intervention for children. The project combined an outcome research, conducted for the validation of a psychotherapy program for children with behavioral and emotional problems, with a mixed qualitative-quantitative study for the development and validation of an observation sheet for the analysis of video recordings in the assessment of children’s self-image. Even if the quantitative analysis showed that both the instrument and the program were adequate, the research program cannot be considered a success because of several shortcomings. We describe the strengths and the gaps of the qualitative study, as well as the likely motives for the failure of the entire project. We also include lessons learned and recommendations.
Shifting Minds: A Quantitative Reappraisal of Cognitive-Intervention Research
Authors: Moreau David
Published: October 2020

Recent popular areas of research in psychology suggest that behavioral interventions can have profound effects on our cognitive abilities. In particular, the study of brain training, video gaming, mindset, and stereotype threat all include claims that low-cost, noninvasive manipulations of the environment can greatly affect individual performance. Here, I provide a quantitative reappraisal of this literature, focusing on recent meta-analytic findings. Specifically, I show that effect-size distributions in the four aforementioned areas are best modeled by multiple rather than single latent distributions, suggesting important discrepancies in the effect sizes reported. I further demonstrate that these multimodal characteristics are not typical within the broader field of psychology, using 107 meta-analyses published in three top-tier journals as a comparison. The effect-size distributions observed in cognitive-intervention research therefore appear to be uncommon, and their characteristics are largely unexplained by current theoretical frameworks of cognitive improvement. Before the source of these discrepancies is better understood, the current study calls for constructive skepticism in evaluating claims of cognitive improvement after behavioral interventions and for caution when this line of research influences large-scale policies.
Effect of stance width on posture stability of golfers putting under windy conditions
Authors: Yang Chun-Ju , Tai Mu-Lin , Hu Cheng-ming , Hamill Joseph , Tang Wen-Tzu
Published: October 2020

Golf putting requires accuracy and precision. However, environmental factors can influence the accuracy and stability of the putt. Therefore, the purpose of this study was to investigate the adjustment and stabilization strategies of elite college golfers putting under different wind conditions. A 3 D motion analysis system and two force plates were used to record the kinematic and ground reaction force data of the putting stroke in different conditions of wind and putting stance. The artificial wind was produced from an industrial negative pressure fan to create different wind speeds. Participants were asked to perform three putts to the ‘virtual’ hole with a distance of 15 feet under three wind speeds (none, mid, strong) and three stance width conditions. The results revealed that distance control in strong wind conditions was significantly worse. No significant improvement was found in either distance or direction control when using different stance widths for putting under varying wind speeds. While putting under minor or moderate wind conditions, the player can adjust through self-adjustment on movement control to reduce the impact of external wind on putting performance. However, if the wind speed exceeds to certain threshold value (5.5 m/s), the challenges for golfers to maintain postural stability along the antero-posterior axis increased and led to poor putting distance control. Our results suggest that when putting under windy conditions, elite low-handicap college golfers are able adopt a normal stance in order to minimize a change in their putting protocol.
Tachycardia-induced cardiomyopathy in three consecutive pregnancies
Authors: Pfaller Birgit , Wichert-Schmitt B , Spears Danna , D’Souza Rohan , Silversides Candice K
Published: October 2020

Tachycardia-induced cardiomyopathy is rare during pregnancy and is reversible when the underlying arrhythmia is effectively treated. Management can be complex due to the risks of antiarrhythmic medications and cardiac interventions on the developing fetus. The care requires a well-coordinated multidisciplinary team of cardiologists, electrophysiologists, and maternal-fetal specialists. In this report, we describe a case of recurrent atrial tachycardia-induced cardiomyopathy in pregnancy.
The patient-specific implant created with 3D printing technology in treatment of a severe open distal humerus fracture with complete loss of the lateral column
Authors: Luenam Suriya , Kosiyatrakul Arkaphat , Phakdeewisetkul Kantapat , Puncreobutr Chedtha
Published: October 2020

The open distal humeral fracture associated with the major loss of the articular surface and bony structure is a challenging problem for orthopedic surgeons. In this case report, we describe a case of complete missing lateral column of the distal humerus with severe articular destruction of capitellum and lateral trochlear ridge which was treated with the patient-specific implant created with three-dimensional printing technology. Apart from anatomic replacement of the articular surface, the lateral collateral ligament complex and extensor muscle which are the key soft tissue stabilizers of elbow were repaired by reattaching their bony origins to the impacted iliac crest bone graft inside the implant. Due to the favorable result at 2-year follow-up, this modality is a potentially viable surgical option in treating of the severe open distal humeral fracture associated with entire lateral condylar damage.
Empathy of Medical Students and Compassionate Care for Dying Patients: An Assessment of “No One Dies Alone” Program
Authors: Hojat Mohammadreza , DeSantis Jennifer , Ney David B , DeCleene-Do Hannah
Published: October 2020

The “No One Dies Alone” (NODA) program was initiated to provide compassionate companions to the bedside of dying patients. This study was designed to test the following hypotheses: (1) Empathy scores would be higher among medical students who volunteered to participate in the NODA program than nonvolunteers; (2) Spending time with dying patients would enhance empathy in medical students. Study sample included 525 first- and second-year medical students, 54 of whom volunteered to participate in the NODA program. Of these volunteers, 26 had the opportunity to visit a dying patient (experimental group), and 28 did not, due to scheduling conflicts (volunteer control group). The rest of the sample (n = 471) comprised the “nonvolunteer control group.” Comparisons of the aforementioned groups on scores of the Jefferson Scale of Empathy confirmed the first research hypothesis ( P < .05, Cohen d = 0.37); the second hypothesis was not confirmed. This study has implications for the assessment of empathy in physicians-in-training, and timely for recruiting compassionate companion volunteers (armed with personal protective equipment) at the bedside of lonely dying patients infected by COVID-19.
Alternative graphical displays for the monitoring of epidemic outbreaks, with application to COVID-19 mortality
Authors: Perneger Thomas , Kevorkian Antoine , Grenet Thierry , Gallée Hubert , Gayet-Ageron Angèle
Published: October 2020

Background

Classic epidemic curves – counts of daily events or cumulative events over time –emphasise temporal changes in the growth or size of epidemic outbreaks. Like any graph, these curves have limitations: they are impractical for comparisons of large and small outbreaks or of asynchronous outbreaks, and they do not display the relative growth rate of the epidemic. Our aim was to propose two additional graphical displays for the monitoring of epidemic outbreaks that overcome these limitations.

Methods

The first graph shows the growth of the epidemic as a function of its size; specifically, the logarithm of new cases on a given day, N(t), is plotted against the logarithm of cumulative cases C(t). Logarithm transformations facilitate comparisons of outbreaks of different sizes, and the lack of a time scale overcomes the need to establish a starting time for each outbreak. Notably, on this graph, exponential growth corresponds to a straight line with a slope equal to one. The second graph represents the logarithm of the relative rate of growth of the epidemic over time; specifically, log10(N(t)/C(t-1)) is plotted against time (t) since the 25th event. We applied these methods to daily death counts attributed to COVID-19 in selected countries, reported up to June 5, 2020.

Results

In most countries, the log(N) over log(C) plots showed initially a near-linear increase in COVID-19 deaths, followed by a sharp downturn. They enabled comparisons of small and large outbreaks (e.g., Switzerland vs UK), and identified outbreaks that were still growing at near-exponential rates (e.g., Brazil or India). The plots of log10(N(t)/C(t-1)) over time showed a near-linear decrease (on a log scale) of the relative growth rate of most COVID-19 epidemics, and identified countries in which this decrease failed to set in in the early weeks (e.g., USA) or abated late in the outbreak (e.g., Portugal or Russia).

Conclusions

The plot of log(N) over log(C) displays simultaneously the growth and size of an epidemic, and allows easy identification of exponential growth. The plot of the logarithm of the relative growth rate over time highlights an essential parameter of epidemic outbreaks.
Knowledge, skills and attitudes of older people and staff about getting up from the floor following a fall: a qualitative investigation
Authors: Swancutt Dawn R. , Hope Suzy V. , Kent Benjamin P. , Robinson Maria , Goodwin Victoria A.
Published: October 2020

Background

Falls are the most common reason for ambulance callouts resulting in non-conveyance. Even in the absence of injury, only half of those who fall can get themselves up off the floor, often remaining there over an hour, increasing risk of complications.

There are recognized techniques for older people to learn how to get up after a fall, but these are rarely taught. The aim of this study was to develop an understanding of attitudes of older people, carers and health professionals on getting up following a fall.

Methods

A qualitative focus group and semi-structured interviews were conducted with 28 participants, including community-dwelling older people with experience of a non-injurious fall, carers, physiotherapists, occupational therapists, paramedics and first responders. Data were transcribed and analysed systematically using the Framework approach. A stakeholder group of falls experts and service users advised during analysis.

Results

The data highlighted three areas contributing to an individual’s capability to get-up following a fall: the environment (physical and social); physical ability; and degree of self-efficacy (attitude and beliefs about their own ability). These factors fell within the wider context of making a decision about needing help, which included what training and knowledge each person already had to manage their fall response.

Staff described how they balance their responsibilities, prioritising the individual’s immediate needs; this leaves limited time to address capability in the aforementioned three areas. Paramedics, routinely responding to falls, only receive training on getting-up techniques from within their peer-group. Therapists are aware of the skillset to breakdown the getting-up process, but, with limited time, select who to teach these techniques to.

Conclusion

Neither therapists nor ambulance service staff routinely teach strategies on how to get up, meaning that healthcare professionals largely have a reactive role in managing falls. Interventions that address the environment, physical ability and self-efficacy could positively impact on peoples’ capability to get up following a fall. Therefore, a more proactive approach would be to teach people techniques to manage these aspects of future falls and to provide them easily accessible information.
Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore
Authors: Ge Lixia , Yap Chun Wei , Heng Bee Hoon , Tan Woan Shin
Published: October 2020

Background

Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore.

Methods

Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables.

Results

In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2–6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1–8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3–30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1–21.1) in the six-month period prior to the baseline and in subsequent 6 months (IRR: 3.3, 95%CI: 1.6–7.1; 6.4, 2.4–17.2; 5.8, 1.3–25.8; 13.1, 4.9–35.0; respectively), controlling for covariates.

Conclusions

Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.
Prospective payment system and racial/ethnic disparities: a national retrospective observational study in anaemia complication among end-stage renal disease patients in the US
Authors: Nguyen Nga TQ. , Maxwell Alexander P. , Donnelly Michael , O’Neill Ciaran
Published: October 2020

Background

A series of policy changes in 2011 altered reimbursement arrangements and guidance on use of erythropoiesis-stimulating agents for end-stage renal disease (ESRD) patients with anaemia in the US. While the policy changes were principally directed at care delivered in an outpatient setting, these had the potential to affect inpatient care also. This study used HCUP-NIS data (2008–2016) to examine trends in recorded anaemia among ESRD hospitalizations and analyse disparities in inpatient outcomes among ethnic groups following policy changes.

Methods

The International Classification of Diseases codes were used to identify ESRD admissions, recorded anaemia due to chronic kidney disease (CKD), and to generate an age-adjusted Deyo-Charlson comorbidity index. Linear splines with a knot placed at the time point of policy changes and multivariable logistic regression were used to examine the likelihood of recorded anaemia, adjusted for a range of socio-demographic and clinical covariates. Difference-in-difference analyses investigated the impact of policies on recorded anaemia. Other outcomes included hospital cost, mortality and place of discharge.

Results

The percentage of inpatient episodes with recorded anaemia arising from CKD increased from 26.2% in 2008 to 50.0% in 2016. Anaemia was more likely to be recorded as a complication of ESRD among minority ethnic groups and Native American admissions, in particular, (OR 1.20, 95%CI 1.15–1.25) relative to White American admissions; and these disparities widened following changes to reimbursement. Minorities were less likely to die in hospital and to be discharged to another healthcare facility, and (with the exception of Black American admissions) they were more expensive to treat.

Conclusions

Our findings provide evidence of an increase in recorded anaemia consistent with a shift of patients from outpatient to inpatient settings in the wake of changes to reimbursement enacted in 2011. In addition, the study highlights the existence of ethnic disparities that widened after the policy initiated reimbursement changes.
Exploring the experiences of stroke patients treated with transcranial magnetic stimulation for upper limb recovery: a qualitative study
Authors: van Lieshout Eline CC , Jacobs Lilliane D , Pelsma Maike , Dijkhuizen Rick M , Visser-Meily Johanna MA
Published: October 2020

Background

Transcranial magnetic stimulation (TMS) treatments have shown promise in improving arm recovery in stroke patients. Currently, little is known about patients’ experiences with repetitive TMS treatment, and this lack of knowledge may affect optimal implementation in clinical practice. The aim of this explorative study was to gain insight in the perceived effects and experiences of the design and delivery of a rTMS treatment for upper limb recovery from the perspectives of stroke patients.

Methods

This qualitative study was conducted as part of a randomized controlled trial (RCT) in a specialized rehabilitation center. Data were collected through face-to-face semi-structured interviews with 13 stroke patients who completed a 10-day rTMS intervention for upper limb recovery. The interviews were recorded, transcribed verbatim and analyzed using thematic analysis.

Results

The major themes that emerged from the patients’ feedback were the following: positive experiences of the treatment (experienced physical effects, comfort, therapeutic relationship, receiving information, learning about the brain, no burden of added rTMS treatment session, no unpleasant aspects), concerns (effects of stimulation of the brain, equipment, logistics), general experience of recovery, experienced psychological effects (grateful, sense of purpose, recovery as extra motivation to exercise, disappointment and hope of group allocation), and motivation to participate (personal benefit and cognitions, altruism). Important components related to the positive experience of the design and delivery of the treatment included comfort (i.e. moment of relaxation) and the sensation of a painless treatment without side-effects. Key concerns included uncertainty and anxiety about possible negative consequences and group allocation.

Conclusions

This study demonstrates that rTMS is well accepted by stroke patients with an upper limb paresis. Besides the expectation of a therapeutic benefit, the patients reported various psychological effects. Positive experiences, such as the provision of a short moment of relaxation each day, could have practical implications for clinical stroke rehabilitation settings aimed at improving patient satisfaction. Explanation about and feedback from routine motor recovery progression monitoring at fixed times post-stroke is also valued by patients. Negative emotions may be limited or avoided by transparent and recurrent information delivery in future trials.
Prior treatment status: impact on the efficacy and safety of teriflunomide in multiple sclerosis
Authors: Comi Giancarlo , Freedman Mark S. , Meca-Lallana José E. , Vermersch Patrick , Kim Byoung Joon , Parajeles Alexander , Edwards Keith R. , Gold Ralf , Korideck Houari , Chavin Jeffrey , Poole Elizabeth M. , Coyle Patricia K.
Published: October 2020

Background

In this pooled, post hoc analysis of a phase 2 trial and the phase 3 TEMSO, TOWER, and TENERE clinical trials, long-term efficacy and safety of teriflunomide were assessed in subgroups of patients with relapsing multiple sclerosis (MS) defined by prior treatment status.

Methods

Patients were classified according to their prior treatment status in the core and core plus extension periods. In the core period, patients were grouped according to treatment status at the start of the study: treatment naive (no prior disease-modifying therapy [DMT] or DMT > 2 years prior to randomization), previously treated with another DMT (DMT > 6 to ≤24 months prior to randomization), and recently treated with another DMT (DMT ≤6 months prior to randomization). In the core plus extension period, patients were re-baselined to the time of starting teriflunomide 14 mg and grouped according to prior treatment status at that time point. Efficacy endpoints included annualized relapse rate (ARR), probability of confirmed disability worsening (CDW) over 12 weeks, and Expanded Disability Status Scale (EDSS) score. The incidence of adverse events was also assessed.

Results

Most frequently received prior DMTs at baseline were glatiramer acetate and interferon beta-1a across treatment groups. Teriflunomide 14 mg significantly reduced ARR versus placebo in the core period, regardless of prior treatment status. In the core and extension periods, adjusted ARRs were low (0.193–0.284) in patients treated with teriflunomide 14 mg across all subgroups. Probability of CDW by Year 4 was similar across subgroups; by Year 5, the percentage of patients with 12-week CDW was similar in treatment-naive patients and patients recently treated with another DMT (33.9 and 33.7%, respectively). EDSS scores were stable over time in all prior-treatment subgroups. There were no new or unexpected safety signals. Limitations include selective bias due to patient attrition, variability in subgroup size, and lack of magnetic resonance imaging outcomes.

Conclusions

The efficacy and safety of teriflunomide 14 mg was similar in all patients with relapsing MS, regardless of prior treatment history.

Trial registration

Phase 2 trial core: NCT01487096; Phase 2 trial extension: NCT00228163; TEMSO core: NCT00134563; TEMSO extension: NCT00803049; TOWER: NCT00751881; TENERE: NCT00883337.
Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study
Authors: Mengesha Sintayehu , Dangisso Mesay Hailu
Published: October 2020

Background

Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden on parents and their family. Studies on stillbirth are scarce in southern Ethiopia. An assessment of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions. Therefore, we assessed the burden of stillbirths and associated factors in Yirgalem Hospital, southern Ethiopia.

Methods

A facility based cross-sectional study was conducted between 1 August 2015 and 30 July 2016. We randomly selected medical records of pregnant women from a hospital delivery registry. Bivariate analysis was employed to assess the association between independent and dependent variables using chi-square with significant p-value. Multivariate logistic regression was used to identify independent risk factors for stillbirths and to control for confounding variables.

Results

Of 374 reviewed records of pregnant women, 370 were included for the study. The magnitude of stillbirths was 92 per 1000 births. Fifteen (44.1%) of fetal deaths occurred after admission to the hospital. In multivariate logistic regression, stillbirths were higher among low birth-weight babies (< 2500grams) (adjusted odds ratio (AOR): 10.70, 95% CI 3.18–35.97) than normal birth-weight babies (2500-<4000). Pregnant women who experienced a prolonged labour for more than 48 hours were 12 times (AOR: 12.15, 95% CI 1.76–84.12) more likely to have stillbirths than pregnant women without a prolonged labour. Pregnant women with obstetric complications were 18.9 times more likely to have stillbirths than pregnant women without obstetric complications. Similarly, pregnant women with at least two pregnancies were more likely to have stillbirths than pregnant women with less than two pregnancies (AOR: 4.39, 95% CI 1.21–15.85).

Conclusions

We found a high burden of stillbirths in the study setting. Modifiable risk factors contributed to a higher risk of stillbirths; therefore, tailored interventions such as early identification and management of prolonged labour and obstetric complication at each level of health system could avert preventable stillbirths.