bluuebunny/crossref_metadata_2025 huggingface dataset:
Alterations in shoulder kinematics are associated with shoulder pain during wheelchair propulsion sprints
Authors: Briley Simon J. , Vegter Riemer J. K. , Goosey‐Tolfrey Victoria L. , Mason Barry S.
Published: May 2022

The study purpose was to examine the biomechanical characteristics of sports wheelchair propulsion and determine biomechanical associations with shoulder pain in wheelchair athletes. Twenty wheelchair court‐sport athletes (age: 32 ± 11 years old) performed one submaximal propulsion trial in their sports‐specific wheelchair at 1.67 m/s for 3 min and two 10 s sprints on a dual‐roller ergometer. The Performance Corrected Wheelchair User's Shoulder Pain Index (PC‐WUSPI) assessed shoulder pain. During the acceleration phase of wheelchair sprinting, participants propelled with significantly longer push times, larger forces, and thorax flexion range of motion (ROM) than both the maximal velocity phase of sprinting and submaximal propulsion. Participants displayed significantly greater peak glenohumeral abduction and scapular internal rotation during the acceleration phase (20 ± 9° and 45 ± 7°) and maximal velocity phase (14 ± 4° and 44 ± 7°) of sprinting, compared to submaximal propulsion (12 ± 6° and 39 ± 8°). Greater shoulder pain severity was associated with larger glenohumeral abduction ROM (r = 0.59, p = 0.007) and scapular internal rotation ROM (r = 0.53, p = 0.017) during the acceleration phase of wheelchair sprinting, but with lower peak glenohumeral flexion (r = −0.49, p = 0.030), peak abduction (r = −0.48, p = 0.034), and abduction ROM (r = −0.44, p = 0.049) during the maximal velocity phase. Biomechanical characteristics of wheelchair sprinting suggest this activity imposes greater mechanical stress than submaximal propulsion. Kinematic associations with shoulder pain during acceleration are in shoulder orientations linked to a reduced subacromial space, potentially increasing tissue stress.
Characterization of the novel HLA‐C*07:1001N allele by next‐generation sequencing
Authors: Gatouillat Grégory , Tonye‐Libyh Marcelle , Tabary Thierry , Pham Bach Nga , Giusti Delphine
Published: May 2022

HLA‐C*07:1001N differs from HLA‐C*07:01:01:01 by a deletion of 17 nucleotides in exon 1.
Molecular detection and risk factors associated with multidrug‐resistant Campylobacter jejuni from broiler cloacal and meat samples in Bangladesh
Authors: Islam Md. Sirazul , Hasib Farazi Muhammad Yasir , Nath Chandan , Ara Jahan , Logno Tahia Ahmed , Uddin Md. Helal , Khalil Md. Ibrahim , Dutta Pronesh , Das Tridip , Chowdhury Sharmin
Published: May 2022

The gastrointestinal tract of poultry is a potential source of Campylobacter jejuni. Here, the prevalence, risk factors, antimicrobial susceptibility profile and genetic relationship of C. jejuni were studied in broilers from farms and meat from live bird markets (LBMs) and super shops (SS). Pooled cloacal samples were obtained from farms in six districts of Bangladesh between June 2019 and March 2020. Pooled meat samples were obtained from LBMs and SS in the Chattogram district. Microbial culture, polymerase chain reaction (PCR), antimicrobial susceptibility tests were used to detect multidrug‐resistant C. jejuni. A positive PCR amplicon was validated by mapA partial gene sequencing and subsequent phylogenetic analysis. In total, 12.5% (95% CI: 8.5–17.7%) of farms (N = 216) and 27.1% (95% CI: 15.28–41.85%) of LBMs and SS (N = 48) tested positive for C. jejuni. Moreover, 98% of the isolates were multidrug‐resistant, with 86% resistant to five or more antimicrobial groups. Multivariable logistic regression analysis showed a downtime of <14 days, no separate footwear for shed access, and more than one person entering the sheds were significantly associated with C. jejuni colonization. Phylogenetic analysis revealed a strong relationship between C. jejuni strains obtained in Bangladesh and strains isolated in India, South Africa and Grenada from humans, pigs and bats. This study revealed significant contamination of broiler meat with Campylobacter spp. and C. jejuni. Potential sources of contamination and anthropogenic factors associated with the alarming prevalence of C. jejuni identified in this study would aid in reducing the growing risks of broiler‐associated pathogens.
Breathing in Duchenne muscular dystrophy: translation to therapy
Authors: Mhandire Doreen Z. , Burns David P. , Roger Angela L. , O'Halloran Ken D. , ElMallah Mai K.
Published: May 2022

Duchenne muscular dystrophy (DMD) is an X‐linked neuromuscular disease caused by a deficiency in dystrophin – a structural protein which stabilises muscle during contraction. Dystrophin deficiency adversely affects the respiratory system leading to sleep‐disordered breathing, hypoventilation, and weakness of the expiratory and inspiratory musculature, which culminate in severe respiratory dysfunction. Muscle degeneration‐associated respiratory impairment in neuromuscular disease is a result of disruptions at multiple sites of the respiratory control network, including sensory and motor pathways. As a result of this pathology, respiratory failure is a leading cause of premature death in DMD patients. Currently available treatments for DMD respiratory insufficiency attenuate respiratory symptoms without completely reversing the underlying pathophysiology. This underscores the need to develop curative therapies to improve quality of life and longevity of DMD patients. This review summarises research findings on the pathophysiology of respiratory insufficiencies in DMD disease in humans and animal models, the clinical interventions available to ameliorate symptoms, and gene‐based therapeutic strategies uncovered by preclinical animal studies.

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Secondary Reflector and Receiver Positions for Uniform Heat Flux Distribution in Parabolic Trough Solar Thermal Collector
Authors: V Baiju , S Shajan
Published: May 2022

The distributions of heat flux over the circumference of the receiver tubes have an immense influence on the performance and reliability of the parabolic trough solar thermal collectors. The location of the receiver tube and the secondary reflector configuration may largely influence the performance of the system. Therefore, in this study, the effect of receiver tube position and parabolic secondary reflector configuration has been analyzed, and the non-uniformity of solar flux distribution, heat gradient, and power output has been compared. The results of the Monte Carlo ray-tracing analysis to homogenize the receiver tube flux distribution and maximize the output power, making the use of the cutting edge solar optical simulation tool Tonatiuh, has been presented. A parabolic trough collector with a rim angle of 80 deg and aperture area of 40 m2 have been used for the analysis. It has been confirmed that the circumferential heat flux gradient and the local hot spot could be greatly diminished, while the power output tended to reduce slightly due to the shading effect of the secondary reflector. Under the conditions investigated in this work, although the output power decreased by 4.83%, flux gradient reduced significantly, and the non-uniformity of flux distribution has reduced from 0.9757 to 0.5176. A simple design procedure for receiver tube position and secondary reflector configurations to homogenize the receiver tube temperature distribution has also been proposed.
Novel Assessment and Classification of Monthly Average Daily Global Solar Radiation Models Through a Figure of Merit Called Irradiation Time Equivalence: Analysis of 70 Regression Models Based on Air Temperature and Sunshine Hours Predictors
Authors: De Souza Keith
Published: May 2022

Irradiation time equivalence pioneers the classification of models that predict monthly average daily global solar radiation on a horizontal surface based on their double cross-validation performances. By exploiting indigenous irradiation data, novel irradiation-based models can be created and used to classify prediction models, thereby facilitating a deeper understanding of model performance beyond routine summary statistics. The concept was demonstrated by formulating novel 1-hour and 2-hour irradiation-based models to predict monthly average daily global horizontal irradiation. Double cross-validations of the two irradiation-based models and 70 existing regression models were performed using a pair of 5-year subsets. The 70 models used the measured meteorological predictors of air temperature and sunshine hours, either alone or combined. The irradiation time equivalence of a model evaluated under double cross-validation has been defined as the minimum number of hours of measured irradiation needed to predict the monthly average daily irradiation in an average year, with a root mean square error less than or equal to that of the model. Despite their intracompetitiveness, all 44 temperature-based models had an irradiation time equivalence of 1 h, while the remaining 26 models that contained the sunshine-hours predictor were classified with a higher-performance rank of 2 h. An irradiation time equivalence scale extending to 13 h was also developed to cater to the classification of higher-performance models. This fresh perspective on model performance directs future investigations toward determining whether prediction models exhibit global classification constancy.
The Effect of Pitch on Heat Transfer to an Immersed Heat Exchanger in a Solar Thermal Storage Tank With and Without a Baffle
Authors: Nicodemus Julia Haltiwanger , Smith Joshua , Holme Alexander , Johnson Sarah , Petitt Kyle
Published: May 2022

The effect of the pitch of a copper coil heat exchanger immersed in a hot water storage tank on heat transfer from the storage tank to the heat exchanger working fluid is investigated. The storage tank is initially quiescent and full of hot water. The heat exchanger located at the top of the tank has a coil diameter just under the tank diameter and has a pitch of 2, 3, 4, 6, or 12 times the heat exchanger diameter, D. The effect of the pitch is explored both with and without a cylindrical baffle, which creates an annular region with the tank wall that has a width of 1.5D and within which the heat exchanger is located. In experiments without the baffle, increasing the heat exchanger pitch improves the rate of heat transfer to the working fluid. The improved heat transfer is attributed to the increased thermal stratification generated by the larger pitches. In experiments with the baffle, the results for experiments with pitches of 2D, 3D, 4D, and 6D are all very similar, with 3D slightly outperforming the others. Heat transfer to the heat exchanger with a 12D pitch was significantly lower than the others. In experiments both with and without the baffle, the larger pitches resulted in more variation in experimental results, despite strict standards for initial and operating conditions. As in the prior work, the presence of the baffle resulted in significantly higher heat transfer rates compared to respective experiments without the baffle.
Lubrication Properties of Textured CSS-42L Bearing Steel Filled With Sn-Ag-Cu-Ti3C2 Under Harsh Environmental Conditions
Authors: Xue Yawen , Hu Xuelin , Shi Xiaoliang , Huang Qipeng
Published: May 2022

To study tribological enhancements of MXene-Ti3C2 under harsh environmental conditions (acidification, emulsification, and high-temperature oxidation), the textured CSS-42L bearing steel surfaces filled with Sn-Ag-Cu-Ti3C2 (TSs-SACT) were prepared. Under harsh conditions, lubrication properties of TSs-SACT were investigated. The results showed that the vibrations of frictional forces and loads of TSs-SACT with the best antifriction performance were suppressed. The curves of instantaneous frictional forces of TSs-SACT were the smoothest, and the amplitudes of instantaneous loads were reduced. Sn-Ag-Cu-Ti3C2 with good adsorption could inhibit the oil film ruptures, which improves the lubrication. TSs-SACT induced the tribochemical reactions to produce the intermetallic compounds and oxides with good tribological properties, resulting in the uniform profiles with excellent antifriction performance and wear resistance.
Probing copper-boron interactions in the Cu2B8− bimetallic cluster
Authors: Kulichenko Maksim , Chen Wei-Jia , Choi Hyun Wook , Yuan Dao-Fu , Boldyrev Alexander I. , Wang Lai-Sheng
Published: May 2022

Borophenes are atom-thin boron layers that can be grown on coinage metal substrates and have become an important class of synthetic 2D nanomaterials. The interactions between boron and substrates are critical to understand the growth mechanisms of borophenes. Here, we report an investigation of copper-boron interactions in the Cu2B8− bimetallic cluster using photoelectron spectroscopy and quantum chemical calculations. Well-resolved photoelectron spectra are obtained at several photon energies and are combined with theoretical calculations to elucidate the structures and bonding of Cu2B8−. Global minimum searches reveal that Cu2B8− consists of a Cu2 dimer atop a B8 molecular wheel with a long Cu–Cu bond length close to that in Cu2+. Chemical bonding analyses indicate that there is clear charge transfer from Cu2 to B8, and the Cu2B8− cluster can be viewed as a [Cu2+]-borozene complex, [Cu2+][B82–]. In the neutral cluster, no Cu–Cu bond exists and Cu2B8 consists of two Cu+ centers interacting with doubly aromatic B82− borozene. The charge transfer interactions between Cu and boron in the Cu2B8− cluster are analogous to charge transfer from the copper substrate to the first borophene layer recently reported to be critical in the growth of bilayer borophenes on a Cu(111) substrate.
Dope and Deny: A Comparative Study of News Frames in American and Russian Coverage of American and Russian Athletes
Authors: Reed Sada , Harker Jennifer L.
Published: May 2022

This content analysis builds on past studies done on media coverage, rhetorical analyses, and journalistic role enactment by examining American and Russian news publications’ (N = 422) coverage of American and Russian doping scandals between 2013 and 2016. This time frame was selected because it was the height of Lance Armstrong and Major League Baseball doping coverage in the United States and the height of Olympic track-and-field doping coverage in Russia. It also fell between the time the World Anti-Doping Agency ratified its third code, which gave the antidoping organization the authority to conduct independent investigations. The study investigates media framing from the midpoint of the scandal, after the sports persona or sports entity denied using performance-enhancing drugs. Whether American and Russian coverage differ in the use of episodic and thematic frames, where blame is placed, and whether episodic or thematic framing predicts blame placement were all examined. Furthermore, the study investigates both nations’ coverage of “their own” athletes and of athletes from the other nation and analyzes whether or how the rhetorical posture of denial leads to adversarial journalism as a role enactment in coverage of sport-related scandals.
The mechanisms of catalysis and ligand binding for the SARS-CoV-2 NSP3 macrodomain from neutron and x-ray diffraction at room temperature
Authors: Correy Galen J. , Kneller Daniel W. , Phillips Gwyndalyn , Pant Swati , Russi Silvia , Cohen Aina E. , Meigs George , Holton James M. , Gahbauer Stefan , Thompson Michael C. , Ashworth Alan , Coates Leighton , Kovalevsky Andrey , Meilleur Flora , Fraser James S.
Published: May 2022

The nonstructural protein 3 (NSP3) macrodomain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Mac1) removes adenosine diphosphate (ADP) ribosylation posttranslational modifications, playing a key role in the immune evasion capabilities of the virus responsible for the coronavirus disease 2019 pandemic. Here, we determined neutron and x-ray crystal structures of the SARS-CoV-2 NSP3 macrodomain using multiple crystal forms, temperatures, and pHs, across the apo and ADP-ribose–bound states. We characterize extensive solvation in the Mac1 active site and visualize how water networks reorganize upon binding of ADP-ribose and non-native ligands, inspiring strategies for displacing waters to increase the potency of Mac1 inhibitors. Determining the precise orientations of active site water molecules and the protonation states of key catalytic site residues by neutron crystallography suggests a catalytic mechanism for coronavirus macrodomains distinct from the substrate-assisted mechanism proposed for human MacroD2. These data provoke a reevaluation of macrodomain catalytic mechanisms and will guide the optimization of Mac1 inhibitors.
Persistent CAD activity in memory CD8
+
T cells supports rRNA synthesis and ribosomal biogenesis required at rechallenge
Authors: Claiborne Michael D. , Sengupta Srona , Zhao Liang , Arwood Matthew L. , Sun Im-Meng , Wen Jiayu , Thompson Elizabeth A. , Mitchell-Flack Marisa , Laiho Marikki , Powell Jonathan D.
Published: May 2022

Memory CD8
+
T cells are characterized by their ability to persist long after the initial antigen encounter and their capacity to generate a rapid recall response. Recent studies have identified a role for metabolic reprogramming and mitochondrial function in promoting the longevity of memory T cells. However, detailed mechanisms involved in promoting their rapid recall response are incompletely understood. Here, we identify a role for the initial and continued activation of the trifunctional rate-limiting enzyme of the de novo pyrimidine synthesis pathway CAD (carbamoyl-phosphate synthetase 2, aspartate transcarbamylase, and dihydroorotase) as critical in promoting the rapid recall response of previously activated CD8
+
T cells. We found that CAD was rapidly phosphorylated upon naïve T cell activation in an mTORC1-dependent manner, yet remained phosphorylated long after initial activation. Previously activated CD8
+
T cells displayed continued de novo pyrimidine synthesis in the absence of mitogenic signals, and interfering with this pathway diminished the speed and magnitude of cytokine production upon rechallenge. Inhibition of CAD did not affect cytokine transcript levels but diminished available pre-rRNA (ribosomal RNA), the polycistronic rRNA precursor whose synthesis is the rate-limiting step in ribosomal biogenesis. CAD inhibition additionally decreased levels of detectable ribosomal proteins in previously activated CD8
+
T cells. Conversely, overexpression of CAD improved both the cytokine response and proliferation of memory T cells. Overall, our studies reveal a critical role for CAD-induced pyrimidine synthesis and ribosomal biogenesis in promoting the rapid recall response characteristic of memory T cells.
Deep-focus earthquakes: From high-temperature experiments to cold slabs
Authors: Gasc Julien , Daigre Clémence , Moarefvand Arefeh , Deldicque Damien , Fauconnier Julien , Gardonio Blandine , Madonna Claudio , Burnley Pamela , Schubnel Alexandre
Published: May 2022

Deep-focus earthquakes (DFEs) present an interesting scientific challenge in that they occur at depths where brittle failure should be impossible. The fact that their occurrence is confined to locations where subducting lithospheric slabs are crossing through the transition zone suggests that olivine phase transformations may be involved in the production of these earthquakes. Experimental studies have shown that olivine can persist metastably in subducting slabs and that olivine phase transformations can lead to faulting at high pressures. However, it has been argued that large DFEs are too large to be contained within a metastable olivine wedge preserved in the interior of subducting slabs. We demonstrate, using experiments on olivine-analog materials, that transformational faulting can continue to propagate via shear-enhanced melting into the stable high-pressure phase. We also show that transformational faulting is controlled by the ratio between strain rates and the olivine-ringwoodite transformation rates, and extrapolate this relationship to the natural conditions of DFEs. Counterintuitively, these results imply that cold and fast-subducting slabs produce transformational faulting at higher temperatures, which results in more numerous DFEs.
Neodymium isotopes of central Mediterranean phosphatic hardgrounds reveal Miocene paleoceanography
Authors: Cornacchia Irene , Brandano Marco , Agostini Samuele , Munnecke Axel
Published: May 2022

Understanding the causes of the formation of hardgrounds provides insights on the oceanographic evolution of a basin. Phosphate-rich hardground formation interrupted carbonate ramp deposition in the Mediterranean during the Miocene. We analyzed the εNd record of three central Mediterranean hardgrounds to identify the origin of the phosphate-rich waters that formed them within the frame of Mediterranean Miocene paleoceanographic evolution. The Nd isotopes suggest that eastern Mediterranean deep waters were controlled by runoff, in contrast to Atlantic and Indian Ocean waters. This Nd isotope record attests to the weakening of Mediterranean circulation during the Miocene due to closure of the Indian Gateway. Limited exchange with Atlantic shallow seawater led to long residence times for deep waters in the basin. This record indicates the role of upwelling in formation of phosphate hardgrounds and shows the influence of global climate change and local paleoceanographic conditions.
Mercury isotopic composition of igneous rocks from an accretionary orogen: Implications for lithospheric recycling
Authors: Deng Changzhou , Gou Jun , Sun Deyou , Sun Guangyi , Tian Zhendong , Lehmann Bernd , Moynier Frédéric , Yin Runsheng
Published: May 2022

Mercury (Hg) provides critical information on terrestrial planet formation and evolution due to its unique physicochemical properties and multiform isotopic compositions. Current knowledge of Hg is mainly limited to Earth's surface environments, and the understanding of Hg in the Earth's interior remains unclear. Accretionary orogens are major settings for continental crustal growth and crust-mantle interactions. We studied the Hg concentration and isotopic composition of igneous rocks in the eastern Central Asian orogenic belt, using Hg as a proxy to trace the recycling of surface materials in Earth's lithosphere. Our results show low Hg abundances in mafic through felsic igneous rocks (4.93 ± 4.35 ppb, standard deviation [SD], n = 267). Mafic rocks show slightly lower δ202Hg (−2.9‰ ± 0.5‰, SD, n = 24) than intermediate (−2.4‰ ± 0.8‰, SD, n = 58) and felsic (−1.5‰ ± 0.8‰, SD, n = 185) rocks, indicating a chemical stratification of Hg isotopic composition in the continental crust with isotopically lighter Hg in the lower part and heavier Hg in the upper part. Slightly positive Δ199Hg values are observed in mantle-derived mafic (0.07‰ ± 0.06‰, SD) and intermediate (0.06‰ ± 0.07‰, SD) rocks, which agree well with those reported for marine sediments, indicating the involvement of fluids or melts from the oceanic crust. Larger variations of Δ199Hg values (−0.26‰ to +0.21‰, average: 0.01‰ ± 0.08‰, SD, n = 185) are observed in felsic rocks, further indicating recycling of surface Hg from the marine reservoir via slab subduction (reflected by positive values) plus magmatic assimilation of terrestrial Hg (reflected by negative values). Our study demonstrates that Hg isotopes can be a promising tracer for the chemical dynamics of Earth's lithosphere.
Thrice daily consumption of a novel, premeal shot containing a low dose of whey protein increases time in euglycemia during 7 days of free-living in individuals with type 2 diabetes
Authors: Smith Kieran , Taylor Guy S , Brunsgaard Lise H , Walker Mark , Bowden Davies Kelly A , Stevenson Emma J , West Daniel J
Published: May 2022

Introduction

During acute feeding trials, consuming a large dose of whey protein (WP) before meals improves postprandial glucose regulation in people with type 2 diabetes. It is unclear if the reported benefits of premeal WP supplementation are translatable to everyday care or are associated with clinically meaningful, real-world glycemic outcomes. This study examined the application of a novel, premeal shot containing a low dose of WP on parameters of free-living glycemic control in people with type 2 diabetes.

Research design and methods

In a randomized, placebo-controlled, single-blind crossover design, 18 insulin naive individuals with type 2 diabetes ((mean±SD) age, 50±6 years; HbA1c(glycated hemoglobin), 7.4%±0.8%; duration of diabetes, 6±5 years) consumed a ready-to-drink WP shot (15 g of protein) or a nutrient-depleted placebo beverage 10 min before breakfast, lunch, and dinner over a 7-day free-living period. Free-living glucose control was measured by blinded continuous glucose monitoring and determined by the percentage of time spent above range (>10 mmol/L), in euglycemic range (3.9–10.0 mmol/L), below range (<3.9 mmol/L) and mean glucose concentrations.

Results

Mealtime WP supplementation reduced the prevalence of daily hyperglycemia by 8%±19% (30%±25% vs 38%±28%, p<0.05), thereby enabling a 9%±19% (~2 hours/day) increase in the time spent in euglycemia (p<0.05). Mean 24-hour blood glucose concentrations were 0.6±1.2 mmol/L lower during WP compared with placebo (p<0.05). Similar improvements in glycemic control were observed during the waken period with premeal WP supplementation (p<0.05), whereas nocturnal glycemic control was unaffected (p>0.05). Supplemental compliance/acceptance was high (>98%), and no adverse events were reported.

Conclusions

Consuming a novel premeal WP shot containing 15 g of protein before each main meal reduces the prevalence of daily hyperglycemia, thereby enabling a greater amount of time spent in euglycemic range per day over 7 days of free-living in people with type 2 diabetes.

Trial registration number

ISRCTN17563146;www.isrctn.com/ISRCTN17563146
Excess mortality by suicide in high-risk subgroups of suicide attempters: a prospective study of standardised mortality rates in suicide attempters examined at a medical emergency inpatient unit
Authors: Probert-Lindström Sara , Öjehagen Agneta , Ambrus Livia , Skogman Pavulans Katarina , Berge Jonas
Published: May 2022

Objectives

The primary aim of the present study was to investigate the putative excess mortality by suicide in suicide attempters. As a secondary aim, we investigate excess mortality in specific, clinically relevant subgroups: individuals with repeated suicide attempts (RA); individuals who used violent method at the attempt (VA); and those who scored high on the Suicide Intent Scale (HS) at the time of the baseline attempt. Finally, we investigate excess mortality in men and women separately and within 5 years and over 5 years after hospital admission for attempted suicide.

Design

Prospective register-based follow-up for 21–32 years. Standardised mortality ratio (SMR) was calculated for suicide using national census data. Clinically relevant subgroups were investigated separately.

Setting

Medical emergency inpatient unit in the south of Sweden.

Participants

1039 individuals who were psychiatrically assessed at admission to medical inpatient care for attempted suicide between 1987 and 1998.

Outcome measure

Suicide.

Results

The overall SMR for suicide was 23.50 (95% CI 18.68 to 29.56); significantly higher (p<0.001) among women (30.49 (95% CI 22.27 to 41.72)) than men (18.61 (95% CI 13.30 to 26.05)). Mortality was highest within the first 5 years after the index suicide attempt (48.79 (95% CI 35.64 to 66.77)) compared with those who died after 5 years (p<0.001) (14.74 (10.53 to 20.63)). The highest independent SMR was found for VA (70.22 (95% CI 38.89 to 126.80)). In a regression model including RA, VA and HS all contributed significantly to excess suicide mortality.

Conclusions

An elevated risk of premature death by suicide was found in suicide attempters compared with the general population. Assessment of previous suicide attempts is important, even though the attempt/s may have occurred decades ago. When assessing suicide risk, clinicians should consider repeated attempts and whether the attempts involved high suicidal intent and violent method. Healthcare interventions may benefit from targeting identified subgroups of attempters.
Implementation strategies supporting fall prevention interventions in a long-term care facility for older persons: a systematic review protocol
Authors: Albasha Neah , McCullagh Ruth , Cornally Nicola , McHugh Sheena , Timmons Suzanne
Published: May 2022

Introduction

Falls are common among older people in long-term care facilities (LCFs). Falls lead to significant morbidity, mortality and reduced quality of life among residents. Fall prevention interventions have been shown to reduce falls in LCFs. However, this may not always translate to effectiveness in real-world situations. We will conduct a systematic review (SR) to identify the implementation strategies used in fall prevention interventions in LCF, describing the effectiveness of strategies in terms of key implementation outcomes and fall reduction.

Methods and analysis

The search will include scientific papers in electronic databases, including PubMed, CINAHL, Embase, PsycINFO, Scopus and Web of Science, and published theses. The SR will consider all original research that empirically evaluated or tested implementation strategies to support fall prevention interventions in LCF, published in English or Arabic between 1 January 2001 and 31 December 2021, where data are presented on the implementation strategy (eg, audit and feedback, champions) and/or implementation outcome (eg, fidelity). Clinical trials, quasi-experimental studies and quality improvement studies will be eligible for inclusion. Two researchers will complete abstract screening, data abstraction and quality assessments independently. The screening process will be presented using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data will be extracted into a standardised table, including the country, year, authors, type of study, primary clinical outcome (falls rate and/or risk reduction as available), implementation strategy and implementation outcomes. Implementation strategies will be defined and categorised using the Expert Recommendation for Implementing Change Taxonomy. Implementation outcomes will be defined and categorised using the Implementation Outcomes Taxonomy, and clinical outcomes of the intervention effectiveness for falls preventions will be reported as formulated in each study, with a final narrative synthesis of data.

Ethics and dissemination

Ethical approval is not required for this study, and the results will be disseminated via peer-reviewed journals and presented at international conferences.

PROSPERO registration number

CRD42021239604.
Barriers towards deceased organ donation among Indians living globally: an integrative systematic review using narrative synthesis
Authors: Vincent Britzer Paul , Randhawa Gurch , Cook Erica
Published: May 2022

Objectives

To understand the barriers towards deceased organ donation among Indians living globally.

Design

Integrative systematic review using narrative synthesis.

Data sources

CINAHL, Medline full-text, PsycInfo, Scopus, Global Health, Web of Science, and PubMed Central,Indian Journal of Transplantationand Google Scholar.

Time period

1 January 1994 to 31 December 2021.

Participants

Individuals of Indian origin living globally.

Results

Eighty-nine studies were included with more than 29 000 participants and quality of the studies were assessed using Joanna Briggs Institute’s critical appraisal tool. Though majority of the participants had knowledge toward organ donation with a positive influence on willingness, the gap between knowledge and willingness was huge, with minimal registration influenced by the complex sociocultural constructs. Various sociocultural constructs such as family, fear and mistrust, religion, and bodily issues play a vital role. Differences were identified in willingness to donate and register between southern and other regions of India. Indian’s organ donation behaviour in other geographical locations differed based on the socioreligious background of the country they lived in such as in Malaysia, Canada and the UK. However, they were collective in decision-making and had complex sociocultural interference irrespective of the country the individual lived which differed only in their next generations.

Conclusion

Though this study showed the complex relationship, and its influences on organ donation behaviour, lacunae were identified to further understand how such complex interactions determine or inform the behaviour. Also, methodological issues were identified, where this particular population outside India were collectively studied with their neighbouring population which are not homogenous. Studies in India majorly addressed a similar aim using similar methods which produced repetition of studies leading to lack of diversified, wider and in-depth research. Therefore, while this systematic review addressed the barriers toward organ donation among Indians living globally, it also informs various gaps in research and also methodological issues.

PROSPERO registration number

CRD42019155274.
IgG1 pan-neurofascin antibodies define a severe and frequently fatal GBS-like neuropathy which responds to rituximab
Authors: Fehmi Janev , Jon Walters R , Lavin Tim , Keh Ryan , Rossor Alexander M , Munteanu Tudor , Delanty Norman , Roberts Rhys , Baumer Dirk , Rinaldi Simon
Published: May 2022

Importance

Disease modifying treatments in Guillain-Barré syndrome (GBS) are not tailored to the different pathological subtypes. Strategies to prospectively identify sub-sets of patients with specific disease mecha- nisms and inform the use of non-standard therapies may lead to improved outcomes. We present a case series of seven patients with IgG1 subclass pan-neurofascin antibodies.

Results

All seven patients presented with a severe, acute or sub-acute onset, predominantly motor, autoimmune neuropathy. In all but one case the neuropathy was severe enough to warrant mechanical ventilation and intensive care support. Cranial nerve deficits were universally present and autonomic dysfunction was common. Although clinically resembling GBS, the response to standard GBS therapies was poor. Four patients received the B-cell depleting therapy rituximab and showed significant and sustained functional improvement within weeks of treatment. The three remaining patients who did not receive rituximab died.

Conclusions and Relevance

These observations should lead to a re-evaluation of the benefit of nodal/paranodal antibody testing in neuropathies with acute onset, GBS-like presentations. We believe that such testing should form part of the routine diagnostic work up of such patients, and that the identifica- tion of a distinct, serologically-defined disease sub-type should prompt consideration of more targeted immunotherapy. The apparent benefit of rituximab reported here should be evaluated in a well-conduc- ted clinical trial, the design of which must consider the potentially grave outcome in pan-neurofascin antibody-positive patients receiving only standard therapies.

simon.rinaldi@nhs.net
068  Immune checkpoint inhibitors: the neurologist’s role
Authors: Brown Rachel , Spillane Jennifer , Lunn Michael , Zandi Michael , Rees Jeremy , Larkin James , Turajlic Samra , Carr Aisling
Published: May 2022

Over the last decade, immune checkpoint inhibitors (ICIs) have revolutionised treatment and outcomes for an increasing number of cancer types. By ‘removing the breaks’ they boost the anti-tumour immune response, but their effect is non-specific, and a number of systemic toxicities may arise. Neurological toxicity occurs in 1–14% patients depending upon the ICI regime used (Spain et al., 2016). We have developed a collaborative neurotoxicty service with the Royal Marsden Hospital, and demonstrate that early involve- ment of the neurologist is paramount to ensuring effective and efficient care in this patient group.

To date, we have received 24 referrals regarding neurological symptoms in patients receiving ICIs. While half were due to ICI-related neurotoxicity, the remainder were caused by cancer progression (2), neurologi- cal side-effects of either other drugs (3) or systemic immune toxicities (2), or worsening/new ‘conventional’ neurological disorders (5). Therefore in addition to identifying and managing neurological toxicity, the role of the neurologist is to identify where neurological toxicity has not occurred, thus enabling the patient to be treated appropriately, while continuing with potentially life-saving immune therapy. With increasing use of these drugs, more robust understanding of risk, patterns and mechanisms of neurological injury must be established through collaborative, cross-disciplinary work to optimise outcomes in this patient group.

rachel.brown@ucl.ac.uk
075  Top 10 research priorities for patients with primary mitochondrial disease and their carers
Authors: Graves Tracey ,   Rare Mitochondrial Disease Priority Setting Partnership Steering Committee,   Genetic Alliance UK
Published: May 2022

Primary mitochondrial diseases encompass a number of clinical presentations with a spectrum of severity, lack effective disease-modifying therapies and have high mortality. It is therefore vital to know that research meets the needs of people with mitochondrial disease. Priority setting partnerships are an established collaborative methodology bringing patients, charity representatives and clinicians together to establish the most pressing and unanswered research priorities.

We developed a web-based questionnaire, asking patients affected by primary mitochondrial disease, their carers and clinicians to pose their research questions. This yielded 709 questions from 50 patients, 47 carers and 50 clinicians. These were grouped into themes and filtered to exclude unanswerable questions. A literature search was performed to determine which of these questions are unanswered. This process resulted in 42 answerable questions. Patients, carers and clinicians were invited again to prioritise these questions and rank them from ‘important’ to ‘less important’ using a web-platform. This identified 24 questions which were then taken forward to a face-to-face workshop attended by a diverse range of patients, carers, charity representatives and clinicians, where the relative merits and strengths of each question was debated to create a definitive ‘top 10 of unanswered research questions for primary mito- chondrial disease’.

tracey.graves@btinternet.com
080  Home mechanical ventilation (HMV) in primary muscle disease: a 12-year single centre cohort study
Authors: Murphy Patrick , Marino Phillip , Howard Leo , Ramsay Michelle , Kaltsakas George , Hart Nick , Howard Robin
Published: May 2022

HMV support is required to manage ventilatory failure in different primary muscle disorders with varying patterns of respiratory muscle weakness and progression.

We present a series of 232 patients with dystrophies who received HMV. The number of patients with the condition and the mean duration of support to death (n=75) or December 2019 was;

Duchenne Muscular dystrophy – 113 patients (64 alive: 49 died) received HMV for 70m (1–240).

Myotonic dystrophy – 42 patients (40:2) - 52m (1–185).

Limb girdle – 36 patients (18:18) – 71m (4–130).

Congenital – 14 (all alive) – 50m (6–101).

Facioscapulohumeral – 9 (8:1) – 94m (46–209)

Becker – 8 (3:5) – 40m (15–120)

Ventilation was generally supported with a NIPPY 3+ device using pressure control mode with varying dependence and interfaces according to disease severity and patient preference. 57% patients had established respiratory failure, 9% underwent tracheostomy, 51% used cough assist devices and 31% underwent gastrostomy.

This series indicates that prolonged survival is possible for patients with primary muscle disease who develop respiratory muscle weakness. The ventilation method, the level of home support and the need for adjuvant support over long periods may vary according to the wishes of the patient, the extent of generalized limb and bulbar weakness, and the pattern of progression.

robinhoward@nhs.net
084  Is there a positive correlation between single breath count and forced vital capacity?
Authors: Aslanyan Aram , Boardman Jeremy , Glasse Hannah , Lilleker James , Mohanraj Rajiv
Published: May 2022

Introduction

Monitoring respiratory function is a critical part of the management of patients with acute neuromuscular disease. Single breath count (SBC) testing is often performed as a surrogate for the Forced Vital Capacity (FVC), especially in resource poor environments. However, equivalence of these two tests has not been formally evaluated.

Methods

We will compare the SBC and FVC in 50 healthy adults. Correlation will be evaluated using linear regression and factors influencing the SBC and FVC will be investigated.

Results

To date 10 participants have been recruited (4 male, 6 female, mean age 30 years). Provisional analysis has shown a mean best SBC and FVC was 71 (SD 19) and 4.8 Litres (SD 1.3) respectively. In this small sample a significant correlation between SBC and FVC was demonstrated (p=0.03, R-squared=0.47). Recruitment is on schedule to complete by March 2020 and full results will be available for presentation at the conference.

Discussion

To our knowledge no study has directly compared SBC and FVC in healthy adult population. Our study will provide useful data to help understand the appropriateness of interchanging these tests in clinical practice.

aram.aslanyan@srft.nhs.uk
089  R-CP chemoimmunotherapy in IgM paraproteinaemic neuropathy produces improvements in serological, neurological and neurophysiological outcomes
Authors: Colchester Nancy TH , Allen David , Katifi Haider A , Burt Tracy , Lown Robert N , Pinto Ashwin A , Duncombe Andrew S
Published: May 2022

There is ongoing debate as to the optimum treatment for IgM paraproteinaemic neuropathy, although there is accumulating evidence that rituximab benefits a proportion of patients. We present a case series of 18 patients with IgM paraproteinaemic neuropathy treated with standard R-CP (rituximab, cyclophos- phamide, prednisolone) chemoimmunotherapy. 13 patients were positive for anti-MAG (myelin associ- ated glycoprotein) antibody. The remaining five had a clinical phenotype suggesting that their IgM paraprotein was causative in their neuropathy. Detailed neurological, neurophysiological and serological outcome data were recorded 1 and 2 years post treatment. The treatment was well tolerated. At 2 years, compared to baseline, a statistically significant improvement was seen in paraprotein concentration, anti-MAG titre, MRC sum score and (from the electrophysiology) the distal motor latency. Percentage of patients improving at 2 years was as follows: Overall neuropathy limitation score 56%, MRC sum score 69%, sensory sum score 61%, anti-MAG titre 100%. These responses compare favourably to those seen with rituximab monotherapy, reported in the literature at 30–50%. On long-term follow-up, 3 cases of glio- blastoma were seen, the aetiology of which is unclear. We suggest there is need for further study of the mechanisms both of the clear neurological benefit but also of the potential risk.

ncolchester@yahoo.com
094  Home mechanical ventilation (HMV) in motor neurone disease: a 12 year single centre cohort study
Authors: Kaltsakas George , Ramsay Michelle , Howard Leo , Sheridan Shauna , Murphy Patrick , Marino Phillip , Hart Nick , Howard Robin
Published: May 2022

HMV support for patients living with motor neuron disease MND is recommended by NICE to improve quality of life and survival. Although there are intermediate term outcome data, long-term data are sparse.

From 2007 to 2019, 413 patients (246 male) received HMV; 310 have died (75.0%). Age at onset was 61.4 ±

12.4 years. The duration between onset of symptoms and diagnosis was 13 months (0–104) and between onset of symptoms and referral was 29 months (0–300). At presentation, 37% patients had established res- piratory failure with a further 13% exhibiting incapacitating breathlessness. Survival was 11.9 ± 18.5 months after commencing HMV although the duration of HMV support for those still alive was 26.6 ± 30.5 months. 9.0% received long-term tracheostomy; 53% had gastrostomy feeding tubes and 25.7% cough assist device.

These data show a delay both in establishing a definitive diagnosis of MND and in referring for specialist support. Delaying referral until severe respiratory compromise has developed may reduce the sympto- matic benefits of NIV. Prolonged survival with HMV support is possible but early intervention is essential to optimise clinical management. The data and clinical experience serve to emphasise the importance of early referral for specialist respiratory assessment and management.

robinhoward@nhs.net
096  Maintenance IVIg safe prescribing – audit of proforma and traffic light risk assessment system in NHNN
Authors: Delaney Milo , Gillingham Alexandra , Compton Laura , Kapoor Mahima , Lavin Timothy , Rossor Alexander , Manji Hadi , Reilly Mary , Lunn Michael , Carr Aisling
Published: May 2022

Introduction

We recently published safety data on maintenance IVIg therapy for inflammatory neuropa- thies in similar patient cohorts from NHNN and the Manchester Neurosciences group [1,2]. Based on our findings the following clinical practice changes have been introduced:

Routine monitoring and proactive treatment of vascular risk factors A traffic light system for guidance on appropriate blood testing.

Methods

Analysis of 2 weeks of IVIg admissions in NHNN prior to and within a month of the introduction of the proforma. Ethics was granted by the clinical governance committee.

Results

69 patient episodes were identified. 63(91.3%)day-care admissions, 6(8.7%)inpatient. 34 female (49.3%).18 patients(26.1%) had bloods taken prior to administration, 60(87%) and 30(43.5%) were screened for symptoms of venous and arterial thromboembolism. 2 (2.9%) and 0 were asked about VTE and ATE risk factors. 63 (91.3%) were asked about infectious symptoms. After introduction of the proforma screening for VTE, TTE and infections symptoms and risk improved to 100%. Aprropriate pre-IVIg bloods were taken in 4(6%).

Conclusion

IVIg is effective and low risk therapy for inflammatory neuropathy, however rare and serious complications can occur. We created this proforma to optimise safety monitoring in longterm mainte- nance therapy with reassuring improvements in this pilot review.

milo.delaney@nhs.net
107  Tapia’s syndrome – is the mechanism neuropraxia from intubation or is it more complex?
Authors: Hutchinson Joseph , MacDonald Bridget
Published: May 2022

An otherwise well 23 year old lady had a septorhinoplasty with bilateral implants under general anaesthesia for nasal blockage and right sided nasal deviation.

The operation was successful but six hours later the left side of her tongue felt odd, she had dysphonia and ‘it felt funny to swallow’. She had deviation of the tongue to the left on protrusion; couldn’t quickly it it from side to side; and the sensation on its left side was altered. There wasn’t obvious tongue swelling or haematoma and no weakness or numbness in the face or limbs. Naso-endoscopy confirmed a left vocal cord paralysis.

This was recognised as a left sided hypoglossal and vagal nerve palsy. The ENT and anaesthetic teams, felt that it might have been due to over-packing of the throat causing compression and neuropraxia. Her symptoms substantially improved after 5 days with a course of dexamethasone.

This case will be discussed with reference to both the first described and more recent case reports of Tapia’s syndrome along with the hypothesised mechanisms of injury. Tapia’s syndrome is a thought to be due to pressure during intubation but most case reports follow surgeries with hammering and other sudden applications of force, rather than in emergency situations which would be expected to have more problems resulting from intubation. It seems important that those who resuscitate patients are aware of this potential complication.

hut898@gmail.com