bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep learning-based signal-independent assessment of macular avascular area on 6×6 mm optical coherence tomography angiogram in diabetic retinopathy: a comparison to instrument-embedded software
Authors: Xiong Honglian , You Qi Sheng , Guo Yukun , Wang Jie , Wang Bingjie , Gao Liqin , Flaxel Christina J , Bailey Steven T , Hwang Thomas S , Jia Yali
Published: September 2021

Synopsis

A deep-learning-based macular extrafoveal avascular area (EAA) on a 6×6 mm optical coherence tomography (OCT) angiogram is less dependent on the signal strength and shadow artefacts, providing better diagnostic accuracy for diabetic retinopathy (DR) severity than the commercial software measured extrafoveal vessel density (EVD).

Aims

To compare a deep-learning-based EAA to commercial output EVD in the diagnostic accuracy of determining DR severity levels from 6×6 mm OCT angiography (OCTA) scans.

Methods

The 6×6 mm macular OCTA scans were acquired on one eye of each participant with a spectral-domain OCTA system. After excluding the central 1 mm diameter circle, the EAA on superficial vascular complex was measured with a deep-learning-based algorithm, and the EVD was obtained with commercial software.

Results

The study included 34 healthy controls and 118 diabetic patients. EAA and EVD were highly correlated with DR severity (ρ=0.812 and −0.577, respectively, both p<0.001) and visual acuity (r=−0.357 and 0.420, respectively, both p<0.001). EAA had a significantly (p<0.001) higher correlation with DR severity than EVD. With the specificity at 95%, the sensitivities of EAA for differentiating diabetes mellitus (DM), DR and severe DR from control were 80.5%, 92.0% and 100.0%, respectively, significantly higher than those of EVD 11.9% (p=0.001), 13.6% (p<0.001) and 15.8% (p<0.001), respectively. EVD was significantly correlated with signal strength index (SSI) (r=0.607, p<0.001) and shadow area (r=−0.530, p<0.001), but EAA was not (r=−0.044, p=0.805 and r=−0.046, p=0.796, respectively). Adjustment of EVD with SSI and shadow area lowered sensitivities for detection of DM, DR and severe DR.

Conclusion

Macular EAA on 6×6 mm OCTA measured with a deep learning-based algorithm is less dependent on the signal strength and shadow artefacts, and provides better diagnostic accuracy for DR severity than EVD measured with the instrument-embedded software.
Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: a randomized controlled feasibility trial
Authors: Goff Louise M , Rivas Carol , Moore Amanda , Beckley-Hoelscher Nicholas , Reid Fiona , Harding Seeromanie
Published: September 2021

Introduction

Black-British communities are disproportionately affected by type 2 diabetes (T2D). Structured education programs are a core component of T2D healthcare but they are less successful in people from minority ethnic groups. Culturally tailored T2D education has demonstrated greater benefits than usual care. The aim of our study was to evaluate acceptability, fidelity and trial feasibility of the Healthy Eating and Active Lifestyles for Diabetes (‘HEAL-D’) culturally tailored T2D self-management education and support (DSMES) program.

Research design and methods

A mixed-methods randomized controlled feasibility trial in black-British adults with T2D was conducted. Participants were assigned to control (usual care) or intervention (HEAL-D; 7 sessions, 14 hours of group-based culturally tailored diet and lifestyle education, behavior change support and supervised physical activity), in a ratio of 1:1. Primary outcomes were recruitment and retention rates, intervention attendance and completion. Fidelity was assessed through observations and qualitative evaluation was undertaken with participants and educators.

Results

102 patients responded to invitation letters (n=1335); 63 were randomized but 8 were subsequently deemed ineligible due to high baseline glycosylated hemoglogin (HbA1c) requiring intensive medical management or missing baseline HbA1c measurement. Of the remaining 55 participants (27 intervention, 28 control), 69% were female, 47% were of African and 51% were of Caribbean ethnicity. 93% completed the trial, providing end point data. Intervention attendance was high; 85% completed the program (attendance at ≥5 sessions), and 74% attended ≥6 sessions. The intervention was delivered with acceptable fidelity, although the qualitative evaluations identified some areas of structure and format in need of refinement.

Conclusions

We have shown it is feasible to recruit and randomize black-British adults with T2D to a trial of a culturally tailored DSMES program. We have shown the intervention is highly acceptable for both patients and healthcare providers. A future trial should assess clinical and cost-effectiveness of HEAL-D.

Trial registration number

NCT03531177.
National Early Warning Scores and COVID-19 deaths in care homes: an ecological time-series study
Authors: Stow Daniel , Barker Robert O , Matthews Fiona E , Hanratty Barbara
Published: September 2021

Objectives

To investigate whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes.

Setting

460 care home units using the same software package to collect data on residents, from 46 local authority areas in England.

Participants

6464 care home residents with at least one NEWS recording.

Exposure measure

29 656 anonymised person-level NEWS from 29 December 2019 to 20 May 2020 with component physiological measures: systolic blood pressure, respiratory rate, pulse rate, temperature and oxygen saturation. Baseline values for each measure calculated using 80th and 20th centile scores before March 2020.

Outcome measure

Cross-correlation comparison of time series with Office for National Statistics weekly reported registered deaths of care home residents where COVID-19 was the underlying cause of death, and all other deaths (excluding COVID-19) up to 10 May 2020.

Results

Deaths due to COVID-19 were registered from 23 March 2020 in the local authority areas represented in the study. Between 23 March 2020 and 10 May 2020, there were 5753 deaths (1532 involving COVID-19 and 4221 other causes). We observed a rise in the proportion of above-baseline NEWS beginning 16 March 2020, followed 2 weeks later by an increase in registered deaths (cross-correlation ofr=0.82, p<0.05 for a 2 week lag) in corresponding local authorities. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately 2 weeks before peaks in deaths.

Conclusions

NEWS could contribute to COVID-19 disease surveillance in care homes during the pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.
Risk factors associated with early childhood caries among Wenzhou preschool children in China: a prospective, observational cohort study
Authors: Mei Liqin , Shi Hongying , Wei Zhiyuan , Li Qiao , Wang Xiping
Published: September 2021

Objectives

Early childhood caries (ECC) is a serious health public problem that affects a large proportion of children in China. This study aimed to assess risk factors for the incidence of ECC among Wenzhou (China) preschoolers.

Design

Prospective, observational cohort study.

Setting

Kindergartens (n=6) in Wenzhou, China.

Participants

606 children who were 3–4 years of age and newly arrived in the kindergartens in September 2011.

Methods

This was a longitudinal observational study with a 2-year follow-up of preschoolers of 3–4 years of age in Wenzhou (Southeast China). Oral health data were collected annually after the baseline survey. The risk factors associated with visible caries and increment of decayed, missing and filled teeth (dmft) were analysed through univariable and multivariable regression using generalised estimating equations.

Results

The prevalence of ECC was increasing during the follow-up period (59.8% at enrolment, 71.8% at first year, and 76.4% at second year). Older age (b=0.07; 95% CI: 0.05 to 0.09; p<0.001), caregivers (relatives or nannies) (b=−1.20; 95% CI: −2.23 to –0.16; p=0.023), lower annual family income (¥10 000–¥20 000: b=2.04; 95% CI: 1.04 to 3.04; p<0.001; <¥10 000: b=1.78; 95% CI: 0.65 to 2.92; p=0.002) and more frequent consumption of sugary snacks/drinks at night (sometimes: b=0.88; 95% CI: 0.20 to 1.56; p=0.011; always: b=1.19; 95% CI: 0.13 to 2.25; p=0.028) were independently associated with the increments of dmft. Older age (OR=1.04, 95% CI: 1.03 to 1.05, p<0.001) and more frequent consumption of sweet snacks (OR=1.86, 95% CI: 1.06 to 3.27; p=0.030) were independently associated with a higher risk of visible caries.

Conclusions

The occurrence and severity of ECC were associated with older age, caregivers (relatives or nannies), lower annual family income and more frequent consumption of sweet snacks. It is imperative to strengthen oral health education for parents and limit sugary foods/snacks.
Client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda: a cross-sectional study
Authors: Ouma Simple , Ndejjo Rawlance , Abbo Catherine , Tumwesigye Nazarius M
Published: September 2021

Study objective

To determine the prevalence and associated factors of client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda.

Design and settings

We conducted a cross-sectional study among female sex workers in Gulu district in conflict-affected Northern Uganda.

Participants

The study participants included 300 female sex workers aged 18+ years. The participants were selected using simple random sampling from a database of female sex workers maintained at a national non-governmental organisation in Gulu.

Outcome measure

The outcome measure was self-reported exposure to client-perpetrated gender-based violence.

Methods

We used a pretested semistructured questionnaire to collect data on sociodemographic characteristics, sex work-related characteristics, alcohol use, illicit drug use, HIV status and self-reported exposure to client-perpetrated gender-based violence. Then, data were entered into Epi Info V.7 and analysed using Stata V.14.0.

Results

Among participants, 61.0% reported client-perpetrated gender-based violence. Economic (58.7%) and emotional (52.0%) violence were the most common forms of client-perpetrated gender-based violence in this population. Independently, being: street-based (adjusted OR=9.66, 95% CI 2.78 to 33.5), mobile (adjusted OR=3.21, 95% CI 1.83 to 5.64), HIV-positive (adjusted OR=1.90, 95% CI 1.09 to 3.31) and a low-income earner (<USh200 000 monthly) (adjusted OR=2.26, 95% CI 1.18 to 4.30) were positively associated with exposure to client-perpetrated gender-based violence.

Conclusions

There is a high prevalence of client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda. Furthermore, female sex workers who were street-based, mobile, HIV-positive and low-income earners were more likely to experience client-perpetrated gender-based violence. The ministry of health and the development partners need to provide targeted public health interventions to prevent and manage the rampant gender-based violence among this underserved population.
Vision impairment and differential access to eye health services in Aotearoa New Zealand: protocol for a scoping review
Authors: Rogers Jaymie Tingkham , Black Joanna , Harwood Matire , Wilkinson Ben , Gordon Iris , Ramke Jacqueline
Published: September 2021

Introduction

In Aotearoa New Zealand, Māori and Pacific people experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do not generate routine monitoring reports, so the extent of eye health inequality is unknown. This information is required to plan equitable eye health services. Here we outline the protocol for a scoping review to report the nature and extent of the evidence reporting vision impairment, and the use of eye health services by ethnicity in New Zealand.

Methods and analysis

An information specialist will conduct searches on MEDLINE and Embase, with no limit on publication dates or language. We will search the grey literature via websites of relevant government and service provider agencies. Reference lists of included articles will be screened. Observational studies will be included if they report the prevalence of vision impairment, or any of the main causes (cataract, uncorrected refractive error, macular degeneration, glaucoma or diabetic retinopathy) or report the use of eye health services in New Zealand among people of any age. Two authors will independently review titles, abstracts and full-text articles, and complete data extraction. Overall findings will be summarised using descriptive statistics and thematic analysis, with an emphasis on disaggregation by ethnicity where this information is available.

Ethics and dissemination

Ethical approval has not been sought as our review will only include published and publicly accessible data. We will publish the review in an open access peer-reviewed journal. We anticipate the findings will be useful to organisations and providers in New Zealand responsible to plan and deliver eye care services, as well as stakeholders in other countries with differential access to eye care.

Registration details

The protocol has been registered with Open Science Framework (https://osf.io/yw7xb).
Children’s and adolescents’ experiences with functional abdominal pain: a qualitative study in Norway
Authors: Brodwall Anne , Brekke Mette
Published: September 2021

Objective

Functional gastrointestinal disorders (FGIDs) are common during childhood and adolescence. When a somatic diagnosis is excluded, the healthcare system often terminates contact with the patient. The aim of the present study was to learn more about children’s and adolescents’ experiences with, and reflections on, the causes of their abdominal pain and what could possibly help them.

Design

The study has a qualitative design. Interviews with open questions were carried out by the first author. The conversations were audiotaped, transcribed and analysed by means of qualitative content analysis.

Setting

Children and adolescents referred from general practitioners located in urban and rural regions in two municipals in Norway. In 2016 and 2019, we had interviewed these children’s parents about their child’s abdominal pain. In spring 2020, the children and adolescents were interviewed.

Participants

Twelve children and adolescents aged 10–18 years with FGIDs.

Results

Eight of the children and adolescents had recovered from their abdominal pain, while four still had symptoms. They felt frustrated by not having a diagnosis and by the lack of available treatment. Some who had been absent from school for weeks to months felt isolated and depressed. Focusing on positive thoughts and activities was reported to improve the pain. The abdominal pain could be considered a manifestation of mental problems.

Conclusions

Thinking differently about the symptoms reduced the FGIDs for the children and adolescents. The treating physicians as well as parents and teachers need to help the child focus on changing the mindset of pain.
Retrospective cohort analysis of survival of children living with HIV/AIDS in Mumbai, India
Authors: Acharya Shrikala , Palkar Amol , Sayed Anwar Parvez , Setia Maninder Singh
Published: September 2021

Objectives

To understand the survival in a cohort of children living with HIV/AIDS (CLHAs) and to study the factors associated with survival in CLHAs in government antiretroviral therapy (ART) centres in Mumbai, India.

Design

This is a retrospective cohort analysis.

Setting

Data from electronic ART records of children from 15 ART centres in Mumbai, Maharashtra, India.

Participants

2224 CLHAs registered in one of these ART centres from 2004 until October 2019. CLHAs up to the age of 18 at the time of registration were considered for these analyses.

Primary and secondary outcomes

We accessed the following data: date of test, date of initiation of ART, date of last follow-up, age at the time of registration, gender, potential route of infection, baseline CD4 counts, ART regimen, adherence and presence of co-infection (TB). We estimated the survival probabilities, plotted the Kaplan-Meier survival graphs and estimated HRs for mortality.

Results

The mortality rate in our population was 22.75 (95% CI 20.02 to 25.85) per 1000 person-years. The 1-year survival was 0.92 (95% CI 0.91 to 0.93), 0.89 (95% CI 0.88 to 0.91) at 5 years and 0.85 (95% CI 0.83 to 0.87) at 10 years after initiation of ART. Children with adherence less than 80% had lowest survival in the first year (0.54, 95% CI 0.46 to 0.61). It reduced drastically at 5 and 10 years. After adjusting for demographic and clinical parameters, mortality was associated with poor adherence (<80%) (HR 11.70, 95% CI 8.82 to 15.53; p<0.001). However, CD4 counts of greater than 200 and age more than 1 year were protective.

Conclusions

Poor adherence to ART and low CD4 counts were significantly associated with higher mortality. Adherence counselling should be an important component of CLHA monitoring in all ART centres. It is also important to identify children early in the infection and start ART medications appropriately.
Cardiovascular morbidity and mortality in patients with type 2 diabetes using novel antidiabetic medicines as add-on therapy: an observational real-world study
Authors: Zerovnik Spela , Kos Mitja , Locatelli Igor
Published: September 2021

Objective

To evaluate the effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), compared with dipeptidyl peptidase-4 inhibitors (DPP-4i) as add-on therapy on cardiovascular (CV) morbidity and mortality in patients with type 2 diabetes (T2D).

Design and setting

A nationwide cohort study using three linked healthcare databases from Slovenia (outpatient prescription claims data, hospitalisation claims data and death registry data).

Participants

Patients with T2D with newly introduced DPP-4i (n=3817), GLP-1RA (n=855) or SGLT2i (n=2851) add-on therapy between June 2014 and June 2018.

Primary and secondary outcome measures

The primary outcome was a major adverse CV event (MACE), while the secondary outcomes were CV death and heart failure (HF). The effects of the antidiabetic medicine group on the risk of each outcome were estimated with Cox proportional hazards regression. Intention-to-treat and on-treatment approaches were used.

Results

In the intention-to-treat analysis, SGLT2i as add-on therapy, when compared with DPP-4i, was associated with lower risk of MACE (HR=0.66; 95% CI 0.50 to 0.85; p=0.002) and CV death (HR=0.46; 95% CI 0.30 to 0.73; p=0.001). On-treatment analysis revealed lower HF risk in patients initiating SGLT2i (HR=0.54; 95% CI 0.30 to 0.99; p=0.047). In the intention-to-treat analysis, GLP-1RA add-on therapy was associated with a lower MACE risk when compared with DPP-4i (HR=0.64; 95% CI 0.43 to 0.97; p=0.034), but it had a non-significant effect on CV death (HR=0.62; 95% CI 0.34 to 1.14; p=0.128) and HF (HR=1.39; 95% CI 0.88 to 2.21; p=0.157). The results of on-treatment analyses were in agreement with the results of intention-to-treat analyses.

Conclusions

SGLT2i and GLP-1RA improved CV morbidity and mortality in patients with T2D when compared with DPP-4i as an add-on therapy. The results of this study may serve as a basis for the selection of an optimal add-on antidiabetic medicine to reduce CV morbidity and mortality in patients with T2D in clinical practice.

Trial registration number

EUPAS32558.
Health-seeking behaviour and cost of fever treatment to households in a malaria-endemic setting of northern Ghana: a cross-sectional study
Authors: Dalaba Maxwell Ayindenaba , Welaga Paul , Dalinjong Philip Ayizem , Chatio Samuel , Immurana Mustapha , Alhassan Robert Kaba , Klu Desmond , Manyeh Alfred Kwesi , Agorinya Isaiah , Oduro Abraham , Adongo Philip Baba , Akweongo Patricia
Published: September 2021

Objectives

To examine the health-seeking behaviour and cost of fever treatment to households in Ghana.

Design

Cross-sectional household survey conducted between July and September 2015.

Setting

Kassena-Nankana East and West districts in Upper East region of Ghana.

Participants

Individuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents.

Results

Out of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.

The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1–GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled.

Conclusions

Prompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.
Prevalence and associated factors of insufficient physical activity among elderly people in Bangladesh: a nationally representative cross-sectional study
Authors: Hanif Abu Abdullah Mohammad , Hasan Mehedi , Khan Md Showkat Ali , Hossain Md Mokbul , Shamim Abu Ahmed , Mitra Dipak Kumar , Hossaine Moyazzam , Ullah Mohammad Aman , Sarker Samir Kanti , Rahman S M Mustafizur , Bulbul Md Mofijul Islam , Mridha Malay Kanti
Published: September 2021

Objectives

Insufficient physical activity (IPA) is a crucial risk factor for non-communicable diseases (NCDs). The elderly population has a higher likelihood of suffering from NCDs. We aimed to estimate the prevalence of and factors associated with IPA among the elderly people in Bangladesh.

Methods

We analysed data from the Bangladesh Food Security and Nutrition Surveillance round 2018–2019, collected from 82 rural, non-slum urban and slum clusters selected using multistage cluster sampling. IPA was defined as <150 min of moderate intensity or <75 min of vigorous intensity or equivalent in a typical week. The weighted prevalence of IPA was estimated by gender and across different variables. Crude and adjusted prevalence ratios were calculated using Poisson regression with robust variance.

Results

The weighted prevalence of IPA among elderly people was 38.4%, with a slightly higher prevalence in women (39.7% vs 37.3%). Factors associated with higher prevalence of IPA in both sexes were—higher age, living in non-slum urban areas, unemployed or homemaker, not currently married, sedentary behaviour and self-reported hypertension. Further, >10 years of education, inadequate fruits and vegetable consumption, self-reported asthma and higher waist circumference among men; and higher household income and self-reported diabetes among women were associated with a higher prevalence of IPA.

Conclusions

IPA is highly prevalent among Bangladeshi elderly men and women. Sedentary behaviour, inadequate fruits and vegetable consumption and higher waist circumference were the modifiable factors of IPA. Evidence from this study can guide the development of appropriate interventions to promote healthy ageing in Bangladesh.
Medical student anxiety in caring for dying patients and their family: a cross-sectional study
Authors: Wells Geoffrey , Llewellyn Carrie , Hiersche Andreas , Minton Ollie , Wright Juliet
Published: September 2021

Objectives

To investigate the level of medical student anxiety in caring for a dying patient and their family and identify influencing factors.

Methods

We conducted a cross-sectional survey in a UK medical school to measure medical student anxiety using a validated Thanatophobia Scale questionnaire.

Results

In total, 332 questionnaires were completed. Mean thanatophobia score was 19.5 (SD 7.78, range 7–49). Most respondents were female (67.4%) and did not have a previous undergraduate degree (56%). Median student age was 22 years (IQR 20–24). Year of study influenced anxiety level, with second year students displaying an increase in mean thanatophobia score of 6.088 (95% CI 3.778 to 8.398, p<0.001). No significant differences were observed between final year and first year thanatophobia scores. For each 1-year increase in student age, mean thanatophobia score reduced by −0.282 (95% CI −0.473 to −0.091, p=0.004). Degree status and gender identity did not significantly affect thanatophobia score.

Conclusion

A degree of thanatophobia exists among medical students, with no significant improvement observed by completion of training. Recognising this anxiety to care for the dying earlier in undergraduate curricula will give educators the opportunity to address students’ fears and concerns and better prepare our future doctors for their role in caring for our dying patients and their families.
Laboratory interpretative comments and guidance: clinical and operative outcomes on moderate to severe hyponatraemia patient management
Authors: Montero-San-Martín Blanca , Oliver Paloma , Fernandez-Calle Pilar , Sánchez-Pascuala Callau Juan J , Díaz Almirón Mariana , Alcaide Martín María J , Fernández-Puntero Belen , Duque Alcorta Marta , Valero Recio José M , Martín Quirós Alejandro , de Ceano-Vivas la Calle María , Martín Sánchez Julia , Rivas Becerra Begoña , Vega Cabrera Cristina , Melgosa Hijosa Marta , Buno Soto Antonio
Published: September 2021

Aims

Hyponatraemia is the most common body fluid disorders but often goes unnoticed. Our laboratory incorporated a standardised procedure to help clinicians detect moderate/severe hyponatraemia. The study aims were to evaluate the outcomes on patient care and clinicians’ satisfaction.

Methods

The study, observational and retrospective, included 1839 cases, adult and paediatric patients, with sodium concentration <130 mmol/L. The procedure consisted of interpretative comments in the emergency and core laboratories report and the point-of-care testing blood gas network report. We evaluated hyponatraemia length in two equal periods: before and after the implementation. We conducted a survey addressed to the staff of the clinical settings involved to know their satisfaction.

Results

The median hyponatraemia length decreased significantly from 4.95 hours (2.08–16.57) in the first period to 2.17 hours (1.06–5.39) in the second period. The lack of hyponatraemia patients follow-up was significantly less after the procedure implementation. The survey was answered by 92 (60 senior specialists and 32 residents) out of 110 clinicians surveyed. Ninety of them (98%) answered positively.

Conclusions

We have demonstrated the reduction in the time for diagnosing and management by physicians, the higher uniformity in the time required to solve hyponatraemia episodes following our laboratory procedure and the clinicians’ satisfaction.
Variation in Clinical Characteristics, Outcomes, and Mortality of Hospitalized Patients with COVID-19 during the Second Wave of the Pandemic: A Single-Center Experience
Authors: Mughal Mohsin Sheraz , Kaur Ikwinder Preet , Wang Chang , Alhashemi Reem , Buemio Alvin , Patton Chandler D , Granet Kenneth M
Published: September 2021

As of February 2, 2021, the USA has 26,431,799 reported COVID-19 cases with 446,744 deaths. A high mortality rate (15%–40%) was reported among hospitalized patients with COVID-19 during the first wave of the pandemic. However, data regarding variation in COVID-19-related mortality and severity of illness among hospitalized patients with COVID-19 are heterogeneous. In this retrospective single-center study, we aimed to investigate the demographic characteristics, clinical presentations, disease severity, clinical outcomes, and in-hospital mortality of hospitalized patients with COVID-19 during the second wave of the pandemic. Adults with reverse transcription-PCR-confirmed SARS-CoV-2 infection were included. In-hospital mortality due to COVID-19 was the primary outcome, and intensive care unit admission, acute kidney injury, acute respiratory distress syndrome, respiratory failure requiring intubation, and septic shock were the secondary outcomes. A total of 101 adult patients were hospitalized with COVID-19 during the second wave study period. Of 101 patients, 8 were intubated and 6 died. The median duration of hospital stay was 6 days. Patients in the second wave were more likely to receive dexamethasone and remdesivir and less likely to require invasive mechanical ventilation. In-hospital mortality during the second wave was lower (5.9%) compared with the first wave (15.5%). At the last follow-up date, 86.1% were discharged alive from the hospital, 5.9% died and 7.9% were still in the hospital. Multivariate logistic regression showed higher odds of mortality were associated with higher age and elevated lactate dehydrogenase peak.
Impact on the Fitness of N95 Masks with Extended Use/Limited Reuse and Dry Heat Decontamination
Authors: Zha Mengyi , Alsarraj Jude , Bunch Brandon , Venzon David
Published: September 2021

Substandard use of N95 masks, sometimes combined with dry heat decontamination, lacks safety data. We evaluated the impact of these practices on the fitness of N95 masks. This is a non-human subject research conducted from July to October 2020. 155 masks were used by 12 healthcare workers during 10-hour shifts. Masks were collected at the end of the shift and if the number of donnings/doffings was less than five (‘modified extended use’, ME) or whenever this number reached five (‘limited reuse’, LR), per the recommendation of the Centers for Disease Control and Prevention. Masks that passed an Occupational Safety and Health Administration qualitative fit test underwent a cycle (30 min, 75°C) of dry heat decontamination. After use, 84% (95% CI 77% to 90%) of the masks fit the users, 85% (95% CI 73% to 93%) in ME and 83% (95% CI 73% to 90%) in LR. After dry heat, 86% of the fitted masks (95% CI 78% to 91%) still fit, 93% (95% CI 80% to 98%) in ME and 82% (95% CI 70% to 89%) in LR. If a fit test was not done before decontamination, 72% (95% CI 64% to 79%) of the masks would fit, 79% (95% CI 66% to 88%) in ME and 68% (95% CI 57% to 77%) in LR. Common substandard use preserves fitness of N95 masks up to 85%. One cycle of dry heat decontamination preserves fitness of N95 masks up to 93% when donned/doffed less than five times and fitness is ensured before decontamination. If a fit test is not performed beforehand, dry heat decontamination cannot preserve the fitness of used N95 masks above 80%.
Functional analysis of peripheral and intratumoral neoantigen-specific TCRs identified in a patient with melanoma
Authors: Bräunlein Eva , Lupoli Gaia , Füchsl Franziska , Abualrous Esam T , de Andrade Krätzig Niklas , Gosmann Dario , Wietbrock Lukas , Lange Sebastian , Engleitner Thomas , Lan Huan , Audehm Stefan , Effenberger Manuel , Boxberg Melanie , Steiger Katja , Chang Yinshui , Yu Kai , Atay Cigdem , Bassermann Florian , Weichert Wilko , Busch Dirk H , Rad Roland , Freund Christian , Antes Iris , Krackhardt Angela M
Published: September 2021

Background

Neoantigens derived from somatic mutations correlate with therapeutic responses mediated by treatment with immune checkpoint inhibitors. Neoantigens are therefore highly attractive targets for the development of therapeutic approaches in personalized medicine, although many aspects of their quality and associated immune responses are not yet well understood. In a case study of metastatic malignant melanoma, we aimed to perform an in-depth characterization of neoantigens and respective T-cell responses in the context of immune checkpoint modulation.

Methods

Three neoantigens, which we identified either by immunopeptidomics or in silico prediction, were investigated using binding affinity analyses and structural simulations. We isolated seven T-cell receptors (TCRs) from the patient’s immune repertoire recognizing these antigens. TCRs were compared in vitro by multiparametric analyses including functional avidity, multicytokine secretion, and cross-reactivity screenings. A xenograft mouse model served to study in vivo functionality of selected TCRs. We investigated the patient’s TCR repertoire in blood and different tumor-related tissues over 3 years using TCR beta deep sequencing.

Results

Selected mutated peptide ligands with proven immunogenicity showed similar binding affinities to the human leukocyte antigen complex and comparable disparity to their wild-type counterparts in molecular dynamic simulations. Nevertheless, isolated TCRs recognizing these antigens demonstrated distinct patterns in functionality and frequency. TCRs with lower functional avidity showed at least equal antitumor immune responses in vivo. Moreover, they occurred at high frequencies and particularly demonstrated long-term persistence within tumor tissues, lymph nodes and various blood samples associated with a reduced activation pattern on primary in vitro stimulation.

Conclusions

We performed a so far unique fine characterization of neoantigen-specific T-cell responses revealing defined reactivity patterns of neoantigen-specific TCRs. Our data highlight qualitative differences of these TCRs associated with function and longevity of respective T cells. Such features need to be considered for further optimization of neoantigen targeting including adoptive T-cell therapies using TCR-transgenic T cells.
Paediatric/young versus adult patients with long QT syndrome
Authors: Lee Sharen , Zhou Jiandong , Jeevaratnam Kamalan , Wong Wing Tak , Wong Ian Chi Kei , Mak Chloe , Mok Ngai Shing , Liu Tong , Zhang Qingpeng , Tse Gary
Published: September 2021

Introduction

Long QT syndrome (LQTS) is a less prevalent cardiac ion channelopathy than Brugada syndrome in Asia. The present study compared the outcomes between paediatric/young and adult LQTS patients.

Methods

This was a population-based retrospective cohort study of consecutive patients diagnosed with LQTS attending public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF).

Results

A total of 142 LQTS (mean onset age=27±23 years old) were included. Arrhythmias other than VT/VF (HR 4.67, 95% CI (1.53 to 14.3), p=0.007), initial VT/VF (HR=3.25 (95% CI 1.29 to 8.16), p=0.012) and Schwartz score (HR=1.90 (95% CI 1.11 to 3.26), p=0.020) were predictive of the primary outcome for the overall cohort, while arrhythmias other than VT/VF (HR=5.41 (95% CI 1.36 to 21.4), p=0.016) and Schwartz score (HR=4.67 (95% CI 1.48 to 14.7), p=0.009) were predictive for the adult subgroup (>25 years old; n=58). A random survival forest model identified initial VT/VF, Schwartz score, initial QTc interval, family history of LQTS, initially asymptomatic and arrhythmias other than VT/VF as the most important variables for risk prediction.

Conclusion

Clinical and ECG presentation varies between the paediatric/young and adult LQTS population. Machine learning models achieved more accurate VT/VF prediction.
Impact of risk factors for major cardiovascular diseases: a comparison of life-time observational and Mendelian randomisation findings
Authors: Lind Lars , Ingelsson Martin , Sundstrom Johan , Ärnlöv Johan
Published: September 2021

Background

This study compared the strength and causality of associations between major risk factors for cardiovascular disease (CVD) and the four major CVDs: myocardial infarction, ischaemic stroke, heart failure and atrial fibrillation. Both a long-term follow-up in an observational cohort and Mendelian randomisation (MR) were used for this aim.

Methods

In the Uppsala Longitudinal Study of Adult Men study, 2322 men, all aged 50 years, were assessed for CVD risk factors and then followed for four decades regarding incident CVDs. The two-sample MR part used public available Genome-Wide Association Study (GWAS) data.

Results

In multivariate analyses, systolic blood pressure was overall by far the most important risk factor, since it was related to all four CVDs, both in observational and MR analyses. Body mass index was the second most overall important risk factor, being linked to all four CVDs, except ischaemic stroke, both in observational and MR analyses. Smoking was an important risk factor for ischaemic stroke and heart failure, both in observational and MR analyses, while low-density lipoprotein-cholesterol mainly was related to myocardial infarction. Diabetes was mainly a causal risk factor for incident myocardial infarction and heart failure. Neither HDL-cholesterol nor triglycerides were of major importance as risk factors in these multivariable models.

Conclusion

By combining long-term observational data with genetic data, we show that the impact and causal role of specific established cardiovascular risk factors varies between different major CVDs. Systolic blood pressure was causally related to all four cardiovascular outcomes and was therefore, overall, the most important risk factor.
Small-strain shear modulus of calcareous sand under anisotropic consolidation
Authors: Shi Jinquan , Xiao Yang , Hu Jian , Wu Huanran , Liu Hanlong , Haegeman Wim
Published: September 2021

In this study, the small-strain shear modulus of a calcareous sand was investigated by conducting bender element tests on both horizontal and vertical planes. The effects of sample preparation method, stress path and stress history on the developing of void ratio, the parameters in the modified Hardin Equation, and the stiffness anisotropy were examined. The test results show that the moist tamping samples have the least void ratio variation among the five samples. The void ratio recovery in effective horizontal stress [Formula: see text] = 100 kPa tests is higher than that in the effective vertical stress [Formula: see text] = 100 kPa tests. The samples prepared in the dry state have lower stiffness than those prepared in the moisture state, which is not influenced by the anisotropic stress state. The stiffness anisotropy induced by the sample preparation method is significant under anisotropic consolidation. In [Formula: see text] = 100 kPa tests, the stiffness ratios at the end of the unloading stage are lower than the initial values at the loading stage, which is not found in the [Formula: see text] = 100 kPa tests, meaning that the stress history and stress path could affect the stiffness anisotropy and eliminate the impact of fabric anisotropy.
Effect of biochar applications on soil phosphorus availability under different soil moisture levels
Authors: Li Yuxin , Li Haixiao , Lu Xueqiang
Published: September 2021

Soil moisture level is crucial to soil phosphorus (P) availability; however, there is no quantitative research on the relation between soil P availability and moisture level. In addition, biochar application could also alter soil P availability at different moisture levels. In this study, a 16 d soil incubation experiment was conducted at a laboratory scale to analyze the effects of soil moisture and P fertilization regimes (P-laden biochar fertilizer and conventional mineral P fertilizer) on soil P availability and fractionation. The results showed that soil P availability was positively correlated with soil moisture level (Pearson coefficients ranged from 0.46 to 0.91). High moisture level would lead to less amount of P in readily available fractions under P-laden biochar application. However, even with less P in readily available fractions, P-laden biochar could maintain soil P availability (117.7 mg P·m−2) at a similar level as the conventional P fertilizer (116.1 mg P·m−2).
Generic flexibility of affine cones over del Pezzo surfaces of degree 2
Authors: Kim Jaehyun , Park Jihun
Published: September 2021

Various ample divisors on smooth del Pezzo surfaces of degree [Formula: see text] have been verified to allow polar cylinders in [I. Cheltsov, J. Park and J. Won, Cylinders in del Pezzo surfaces, Int. Math. Res. Not. 2017(4) (2015) 1179–1230]. We show that affine cones over smooth del Pezzo surfaces of degree [Formula: see text] polarized by such ample divisors are flexible in codimension one.

All varieties in this paper are assumed to be defined over an algebraically closed field of characteristic zero.
Implication of Bio-convective Marangoni flow of non-Newtonian material towards an infinite disk subject to exponential space-based heat source
Authors: Waqas Hassan , Yasmin Sumeira , Khan Sami Ullah , Qayyum Sumaira , Khan M. Ijaz , Abbasi Aamar , Sun Tian-Chuan , Malik M. Y.
Published: September 2021

In recent years, the research for enhanced thermal transportation is centered around the utilization of nanostructures to avail the prospective benefits in areas of biomedical, metallurgy, polymer processing, mechanical and electrical engineering applications, food processing, ventilation, heat storage devices, nuclear systems cooling, electronic devices, solar preoccupation, magnetic sticking, bioengineering applications, etc. The thermal aspects of nanoliquids and associated dynamics properties are still necessary to be explored. In this thermal contribution, the flow of Casson nanofluid configured by an infinite disk is analyzed. The significance of Marangoni flow with activation energy, thermal and exponential space-dependent heat source, nonlinear thermal radiation and Joule heating impacts is also incorporated. Similarly, variables are affianced to recast the governing flow expressions into highly coupled nonlinear ODEs. The numerical simulation for the prevailing model is elucidated by applying the bvp4c built-in function of computational commercial software MATLAB. Consequences of sundry parameters, namely, magnetic parameter, Prandtl number, radiation parameter, exponential space-dependent heat source parameter, thermal-dependent heat source parameter, Eckert number, Dufour parameter, Soret number, Schmidt number, Marangoni number and Marangoni ratio parameter, mixed convection parameter, buoyancy ratio parameter, bioconvection Rayleigh number, activation energy parameter, thermophoresis parameter, Brownian motion parameter, bioconvection Lewis number, Peclet number microorganisms difference variable versus involved flow profiles like velocity, temperature, concentration of nanoparticles and microorganism field are obtained and displayed through graphs and tabular data.
Manipulation of thermal radiation by using photonic crystals
Authors: Umar Azka , Jiang Chun
Published: September 2021

This paper focuses on manipulating thermal emission and radiation loss of heat energy in a heat waveguide. A One-Dimensional Photonic Crystal is used as a waveguide clad to prohibit the thermal emission from escaping. The model may reduce the radiation loss of heat energy in the waveguide core, and heat energy can be confined to propagate along the waveguide’s longitude axis. The waveguide clad comprises alternative layers of high and low refractive index materials containing sufficient electromagnetic stop bands to trap the thermal emission from escaping out of the waveguide. The numerical simulation of the model shows that the forbidden bandgap of photonic crystal structures with alternative layers of silica and silicon has width enough to make heat energy be confined within the waveguide core so that efficient heat energy transmission can be achieved along the longitude axis of the waveguide.
Self-gasified biosystems for enhanced oil recovery
Authors: Suleimanov B. A. , Rzayeva S. J. , Akhmedova U. T.
Published: September 2021

Microbial enhanced oil recovery is considered to be one of the most promising methods of stimulating formation, contributing to a higher level of oil production from long-term fields. The injection of bioreagents into a reservoir results in the creation of oil-displacing agents along with a significant amount of gases, mainly carbon dioxide. Earlier, the authors failed to study the preparation of self-gasified biosystems and the implementation of the subcritical region (SR) under reservoir conditions. Gasified systems in the subcritical phase have better oil-displacing properties than nongasified systems. In a heterogeneous porous medium, the filtration profile of gasified liquids in the SR should be more uniform than for a degassed liquid.

Based on experimental studies, the superior efficiency of oil displacement by gasified biosystems compared with degassed ones has been demonstrated. The possibility of efficient use of gasified hybrid biopolymer systems has been shown.
Restaurant Recommendation in Vehicle Context Based on Prediction of Traffic Conditions
Authors: Wang Zehong , Liu Jianhua , Shen Shigen , Li Minglu
Published: September 2021

Restaurant recommendation is one of the most recommendation problems because the result of recommendation varies in different environments. Many methods have been proposed to recommend restaurants in a mobile environment by considering user preference, restaurant attributes, and location. However, there are few restaurant recommender systems according to the internet of vehicles environment. This paper presents a recommender system based on the prediction of traffic conditions in the internet of vehicles environment. This recommender system uses a phased selection method to recommend restaurants. The first stage is to screen restaurants that are on the user’s driving route; the second stage is to recommend restaurants from the user attributes, restaurant attributes (with traffic conditions), and vehicle context, using a deep learning model. The experimental evaluation shows that the proposed recommender system is both efficient and effective.
Relativistic quantum bouncing particles in a homogeneous gravitational field
Authors: Rohim Ar , Ueda Kazushige , Yamamoto Kazuhiro , Lin Shih-Yuin
Published: September 2021

In this paper, we study the relativistic effect on the wave functions for a bouncing particle in a gravitational field. Motivated by the equivalence principle, we investigate the Klein–Gordon and Dirac equations in Rindler coordinates with the boundary conditions mimicking a uniformly accelerated mirror in Minkowski space. In the nonrelativistic limit, all these models in the comoving frame reduce to the familiar eigenvalue problem for the Schrödinger equation with a fixed floor in a linear gravitational potential, as expected. We find that the transition frequency between two energy levels of a bouncing Dirac particle is greater than the counterpart of a Klein–Gordon particle, while both are greater than their nonrelativistic limit. The different corrections to eigen-energies of particles of different nature are associated with the different behaviors of their wave functions around the mirror boundary.