bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of bilirubin and Gilbert syndrome on health: cohort analysis of observational, genetic, and Mendelian randomisation associations
Authors: Hamilton Fergus W , Abeysekera KWM , Hamilton Willie , Timpson Nicholas J
Published: July 2023

Objectives

To compare associations between the Gilbert syndrome genotype in European populations, measured bilirubin concentrations, genetically predicted bilirubin using this genotype, and a wide range of health outcomes in a large cohort.

Design

Cohort study including observational, genetic, and Mendelian randomisation analyses.

Setting

22 centres across England, Scotland, and Wales in UK Biobank (2006-10), with replication in a national Finnish cohort (FinnGen).

Participants

463 060 participants in the UK Biobank were successfully genotyped for a genetic variant (rs887829) that is strongly associated with Gilbert syndrome and 438 056 participants had measured bilirubin concentrations with linked electronic health record data coded using the tenth edition of the International Classification of Diseases. Replication analyses were performed in FinnGen (n=429 209) with linked electronic health record data.

Main outcome measures

Odds ratios for the association between serum bilirubin concentrations, rs887829-T homozygosity (the risk genotype for Gilbert syndrome), genetically predicted bilirubin using rs887829-T allele carriage alone, and a wide range of health outcomes recorded in primary and secondary care.

Results

46 189 participants in UK Biobank (about 10%) were homozygous for rs887829-T defining them as having the genotype characterising Gilbert syndrome. However, only 1701 (3%) of this group had a coded diagnosis of Gilbert syndrome. Variation at this locus explained 37.1% of all variation in measured serum bilirubin. In the observational analyses, higher bilirubin concentrations had strong inverse associations with a wide range of outcomes including overall health status, chronic obstructive pulmonary disease, myocardial infarction, and cholesterol measures. These associations were not identified in people with the Gilbert genotype. We identified associations with genetically predicted bilirubin concentrations and biliary and liver pathology (eg, odds ratio for cholelithiasis 1.16 (95% confidence interval 1.12 to 1.20); P=5.7×10-16) and a novel association with pityriasis rosea (1.47 (1.27 to 1.69), P=1.28×10-7).

Conclusions

Only 3% of participants who are homozygous for rs887829-T have a recorded diagnosis of Gilbert syndrome. Carriers of this genotype have modest increases in the odds of developing biliary pathology and pityriasis rosea. Evidence from the analyses of genetic data suggests that bilirubin has no likely causal role in protection from cardiovascular disease, chronic obstructive pulmonary disease, or other key healthcare outcomes and therefore represents a poor target for therapeutic intervention for these outcomes.
Mind-body exercise interventions for prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic review and meta-analysis
Authors: Tan Leona , Strudwick Jessica , Deady Mark , Bryant Richard , Harvey Samuel B
Published: July 2023

Objective

Mind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations.

Design

Systematic review and meta-analysis.

Methods

A systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges’gand 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses.

Results

Six studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD (g=−0.25, 95% CI −0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms.

Conclusion

Limited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias.

PROSPERO registration number

CRD42020180375
Factors associated with graduation examination results from standardised residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020
Authors: Gao QiSheng , Li Ruoqi , Xia Zhijun , Qu Xianguo , Jiang Ling
Published: July 2023

Objective

Standardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the quality of residency training. This study aimed to analyse the results and associated factors of the graduation examination of standardised residency training in Zhejiang Province in 2020.

Design

Cross-sectional analysis of examination results data.

Setting

Medical and health institutions and universities in Zhejiang Province.

Participants

A total of 5555 examinees took the graduation examination of standardised residency training in Zhejiang Province in 2020.

Primary outcomes

Pass rates of the practical skill examination and written examination.

Results

The pass rates for the practical skill examination and written examination were 91.8% and 96.5%, respectively. Examinees aged 30 and above (adjusted OR (AOR)=0.48, 95% CI 0.26 to 0.89), those with 3 years (AOR=0.19, 95% CI 0.09 to 0.43) and 2 years (AOR=0.61, 95% CI 0.40 to 0.96) of training, those who retook the examination (AOR=0.28, 95% CI 0.20 to 0.391) and those from primary healthcare institutions (AOR=0.56, 95% CI 0.40 to 0.77) were less likely to pass the practical skill examination. Examinees with a postgraduate degree and those from colleges and universities had higher pass rates in the written examination (AOR=6.37, 95% CI 1.95 to 23.34; AOR=2.87, 95% CI 1.40 to 6.65, respectively). Examinees aged 30 and above (AOR=0.08, 95% CI 0.01 to 0.30), those aged between 25 and 30 (AOR=0.22, 95% CI 0.03 to 0.80), those who retook the examination (AOR=0.04, 95% CI 0.03 to 0.07), those from second-level hospitals (AOR=0.58, 95% CI 0.39 to 0.87) and those who failed the practical skill examination (AOR=0.17, 95% CI 0.12 to 0.25) were less likely to pass the written examination.

Conclusions

The pass rate of the graduation examination of standardised residency training was associated with the individual characteristics of the examinees. The results of practical skill examination were related to the results of the written examination.
Concordance and determinants of mothers’ and children’s diets in Nigeria: an in-depth study of the 2018 Demographic and Health Survey
Authors: Akseer Nadia , Tasic Hana , Adeyemi Olutayo , Heidkamp Rebecca
Published: July 2023

Objectives

Improving the diversity of the diets in young children 6–23 months is a policy priority in Nigeria and globally. Studying the relationship between maternal and child food group intake can provide valuable insights for stakeholders designing nutrition programmes in low-income and middle-income countries.

Design

We examined the relationship between maternal and child dietary diversity among 8975 mother–child pairs using the Nigeria 2018 Demographic and Health Survey (DHS). We assessed concordance and discordance between maternal and child food group intake using the McNemar’s χ2test, and the determinants of child minimum dietary diversity (MDD-C) including women MDD (MDD-W) using hierarchical multivariable probit regression modelling.

Setting

Nigeria.

Participants

8975 mother–child pairs from the Nigeria DHS.

Primary and secondary outcome measures

MDD-C, MDD-W, concordance and discordance in the food groups consumed by mothers and their children.

Results

MDD increased with age for both children and mothers. Grains, roots and tubers had high concordance in mother–child dyads (90%); discordance was highest for legumes and nuts (36%), flesh foods (26%), and fruits and vegetables (39% for vitamin-A rich and 57% for other). Consumption of animal source food (dairy, flesh foods, eggs) was higher for dyads with older mothers, educated mothers and more wealthy mothers. Maternal MDD-W was the strongest predictor of MDD-C in multivariable analyses (coef 0.27; 95% CI 0.25 to 0.29, p<0.000); socioeconomic indicators including wealth (p<0.000), mother’s education (p<0.000) were also statistically significant in multivariable analyses and rural residence (p<0.000) was statistically significant in bivariate analysis.

Conclusion

Programming to address child nutrition should be aimed at the mother–child dyad as their food consumption patterns are related and some food groups appear to be withheld from children. Stakeholders including governments, development partners, non-governmental organizations, donors and civil society can act on these findings in their efforts to address undernutrition in the global child population.
Global use of electronic patient-reported outcome systems in nephrology: a mixed methods study
Authors: Anderson Nicola Elizabeth , Kyte Derek , McMullan Christel , Cockwell Paul , Aiyegbusi Olalekan Lee , Verdi Rav , Calvert Melanie
Published: July 2023

Objectives

The use of electronic patient-reported outcome (ePRO) systems to support the management of patients with chronic kidney disease is increasing. This mixed-methods study aimed to comprehensively identify existing and developing ePRO systems, used in nephrology settings globally, ascertaining key characteristics and factors for successful implementation.

Study design

ePRO systems and developers were identified through a scoping review of the literature and contact with field experts. Developers were invited to participate in a structured survey, to summarise key system characteristics including: (1) system objectives, (2) population, (3) PRO measures used, (4) level of automation, (5) reporting, (6) integration into workflow and (7) links to electronic health records/national registries. Subsequent semistructured interviews were conducted to explore responses.

Setting and participants

Eligible systems included those being developed or used in nephrology settings to assess ePROs and summarise results to care providers. System developers included those with a key responsibility for aspects of the design, development or implementation of an eligible system.

Analytical approach

Structured survey data were summarised using descriptive statistics. Interview transcripts were analysed using Codebook Thematic Analysis using domains from the Consolidated Framework for Implementation Research.

Results

Fifteen unique ePRO systems were identified across seven countries; 10 system developers completed the structured survey and 7 participated in semistructured interviews. Despite system heterogeneity, reported features required for effective implementation included early and sustained patient involvement, clinician champions and expanding existing electronic platforms to integrate ePROs. Systems demonstrated several common features, with the majority being implemented within research settings, thereby affecting system implementation readiness for real-world application.

Conclusions

There has been considerable research investment in ePRO systems. The findings of this study outline key system features and factors to support the successful implementation of ePROs in routine kidney care.Cite Now
Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol
Authors: Capdevila Mathieu , De Jong Audrey , Aarab Yassir , Vonarb Aurelie , Carr Julie , Molinari Nicolas , Capdevila Xavier , Brochard Laurent , Jaber Samir
Published: July 2023

Introduction

Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient’s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient’s illness.

Methods and analysis

This will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH2O with positive end expiratory pressure (PEEP) level of 0 cmH2O, PSV 0 cmH2O with PEEP 0 cmH2O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease).

Ethics and dissemination

The study project was approved by the appropriate ethics committee (2019-A01063-54, Comité de Protection des Personnes TOURS - Région Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent.

Trial registration number

NCT04222569.
General practitioners ending their practice and impact on patients’ health, healthcare use and mortality: a protocol for national registry cohort studies in Norway, 2008 to 2021
Authors: Vinjerui Kristin Hestmann , Sarheim Anthun Kjartan , Asheim Andreas , Carlsen Fredrik , Mjølstad Bente Prytz , Nilsen Sara Marie , Pape Kristine , Bjorngaard Johan H
Published: July 2023

Introduction

Continuous general practitioner (GP) and patient relations associate with positive health outcomes. Termination of GP practice is unavoidable, while consequences of final breaks in relations are less explored. We will study how an ended GP relation affects patient’s healthcare utilisation and mortality compared with patients with a continuous GP relation.

Methods and analysis

We link national registries data on individual GP affiliation, sociodemographic characteristics, healthcare use and mortality. From 2008 to 2021, we identify patients whose GP stopped practicing and will compare acute and elective, primary and specialist healthcare use and mortality, with patients whose GP did not stop practicing. We match GP–patient pairs on age and sex (both), immigrant status and education (patients), and number of patients and practice period (GPs). We analyse the outcomes before and after an ended GP–patient relation, using Poisson regression with high-dimensional fixed effects.

Ethics and dissemination

This study protocol is part of the approved project Improved Decisions with Causal Inference in Health Services Research, 2016/2159/REK Midt (the Regional Committees for Medical and Health Research Ethics) and does not require consent. HUNT Cloud provides secure data storage and computing. We will report using the STROBE guideline for observational case–control studies and publish in peer-reviewed journals, accessible in NTNU Open and present at scientific conferences. To reach a broader audience, we will summarise articles in the project’s web page, regular and social media, and disseminate to relevant stakeholders.
Cost–benefit analysis of partnership working between fire and rescue and health services across England and Wales during the COVID-19 pandemic
Authors: Waring Sara , Jones Alaw
Published: July 2023

Objectives

Fire and rescue services undertook a range of additional activities to support the National Health Service (NHS) in managing extreme service demand during the COVID-19 pandemic. This study aims to examine the cost–benefit of partnership work between fire and rescue services and the NHS during the COVID-19 pandemic.

Setting

England and Wales.

Design

A cost–benefit approach was used. Data relating to resources and outcomes was accessed from a National Data Portal commissioned by the National Fire Chiefs Council to record fire and rescue service responses throughout the pandemic. Literature-based economic estimates were applied to establish the potential cost–benefit of fire and rescue services undertaking support activities.

Results

Fire and rescue services commonly undertook eight activities to support ambulance services and hospitals in three key areas: (1) driving ambulances, (2) provision of personal protective equipment for healthcare workers and (3) mass testing and mass vaccination. Benefits outweighed costs for all activities. Total costs were estimated at £93.26 million and total benefits were between £171.46 million and £1.10 billion.

Conclusions

This is the first economic evaluation of partnership working between fire and rescue and health services during a pandemic. Findings highlight the social and economic value of co-operation between fire and rescue services and the NHS and provides important evidence for informing public sector decisions regarding the allocation of resources in future public health crises.
Relationships of illness perception, symptoms response and social support with acute myocardial infarction patients’ prehospital delay in rural China: protocol for a cross-sectional study
Authors: Jin Jingfen , Yang Haifeng , Guo Zhiting , L V Xuebing , Jiang Xiuju , Ding Chuanqi
Published: July 2023

Introduction

The timely treatment of acute myocardial infarction (AMI) patients is of utmost importance, and yet, there remains a significant disparity between urban and rural areas in China due to the unequal distribution of medical resources. The manifestation of symptoms and psychosocial factors play a crucial role in shaping medical decisions for AMI patients. It is well established that minimising prehospital delay (PHD) is crucial for the successful implementation of recanalisation therapy and reducing mortality in out-of-hospital settings. However, there remains a paucity of studies investigating the correlation between illness perception, symptom response, social support, and PHD in AMI patients.

Aim

The aim of this study was to analyse the relationship pathways between symptom response, illness perception, social support and PHD time in patients with AMI in rural areas of China.

Methods

A primary care-based cross-sectional study was designed to investigate the inpatients initially diagnosed with AMI in the emergency department of three tertiary care hospitals in three counties in northern Zhejiang Province by convenience sampling method from January 2023 to December 2023. A minimum of 286 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using logistic regression and structural equation model with PHD as main outcome parameter.

Discussion

This is the first study of the factors influencing PHD in AMI in rural China using structural equation model. Our study will address this gap in the available research. The implementation and findings of this study may provide a reliable basis for reducing PHD in AMI patients in rural areas and establish a relevant theoretical foundation for the implementation of targeted interventions and risk prevention measures in primary care hospitals.
Non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma: protocol
Authors: Karampatakis Georgios Dimitrios , Wood Helen E , Griffiths Chris J , Taylor Stephanie J C , Toffolutti Veronica , Bird Victoria J , Lea Nathan C , Ashcroft Richard E , Day Bill , Coulson Neil S , Panzarasa Pietro , Li Xiancheng , Sheikh Aziz , Relton Clare , Sastry Nishanth , Watson Jane S , Marsh Viv , Mant Jonathan , Mihaylova Borislava , Walker Neil , De Simoni Anna
Published: July 2023

Introduction

In the UK, approximately 4.3 million adults have asthma, with one-third experiencing poor asthma control, affecting their quality of life, and increasing their healthcare use. Interventions promoting emotional/behavioural self-management can improve asthma control and reduce comorbidities and mortality. Integration of online peer support into primary care services to foster self-management is a novel strategy. We aim to co-design and evaluate an intervention for primary care clinicians to promote engagement with an asthma online health community (OHC). Our protocol describes a ‘survey leading to a trial’ design as part of a mixed-methods, non-randomised feasibility study to test the feasibility and acceptability of the intervention.

Methods and analysis

Adults on the asthma registers of six London general practices (~3000 patients) will be invited to an online survey, via text messages. The survey will collect data on attitudes towards seeking online peer support, asthma control, anxiety, depression, quality of life, information on the network of people providing support with asthma and demographics. Regression analyses of the survey data will identify correlates/predictors of attitudes/receptiveness towards online peer support. Patients with troublesome asthma, who (in the survey) expressed interest in online peer support, will be invited to receive the intervention, aiming to reach a recruitment target of 50 patients. Intervention will involve a one-off, face-to-face consultation with a practice clinician to introduce online peer support, sign patients up to an established asthma OHC, and encourage OHC engagement. Outcome measures will be collected at baseline and 3 months post intervention and analysed with primary care and OHC engagement data. Recruitment, intervention uptake, retention, collection of outcomes, and OHC engagement will be assessed. Interviews with clinicians and patients will explore experiences of the intervention.

Ethics and dissemination

Ethical approval was obtained from a National Health Service Research Ethics Committee (reference: 22/NE/0182). Written consent will be obtained before intervention receipt and interview participation. Findings will be shared via dissemination to general practices, conference presentations and peer-reviewed publications.

Trial registration number

NCT05829265.
Advocating uniformity in spine surgery: a practical disease-specific guideline for trial-based economic evaluations
Authors: Schuermans Valérie N E , Droeghaag Ruud , Hermans Sem M M , Smeets Anouk Y J M , Caelers Inge J M H , Hiligsmann Mickaël , van Hemert Wouter L W , Evers Silvia , van Santbrink Henk
Published: July 2023

Objectives

Despite the availability of general and national guidelines for the conduct and reporting of economic evaluations, there is heterogeneity in economic evolutions concerning spine surgery. This is partly the result of differing levels of adherence to the existing guidelines and the lack of disease-specific recommendations for economic evaluations. The extensive heterogeneity in study design, follow-up duration and outcome measurements limit the comparability of economic evaluations in spine surgery. This study has three objectives: (1) to create disease-specific recommendations for the design and conduct of trial-based economic evaluations in spine surgery, (2) to define recommendations for reporting economic evaluations in spine surgery as a complement to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist and (3) to discuss methodological challenges and defining the need for future research.

Design

A modified Delphi method according to the RAND/UCLA Appropriateness Method.

Setting

A four-step process was followed to create and validate disease-specific statements and recommendations for the conduct and reporting of trial-based economic evaluations in spine surgery. Consensus was defined as >75% agreement.

Participants

A total of 20 experts were included in the expert group. Validation of the final recommendations was obtained in a Delphi panel, which consisted of 40 researchers in the field who were not included in the expert group.

Primary and secondary outcome measures

The primary outcome measure is a set of recommendations for the conduct and reporting, as a complement to the CHEERS 2022 checklist, of economic evaluations in spine surgery.

Results

A total of 31 recommendations are made. The Delphi panel confirmed consensus on all of the recommendations in the proposed guideline.

Conclusion

This study provides an accessible and practical guideline for the conduct of trial-based economic evaluations in spine surgery. This disease-specific guideline is a complement to existing guidelines, and should aid in reaching uniformity and comparability.
Comprehensive licensure review and adaptive quizzing assignments for enhancement of end-of-programme exit examination scores in Saudi Arabia: a quasi-experimental study
Authors: Almotairy Monir M , Innab Adnan , Alqahtani Naji , Nahari Ahmed , Alghamdi Reem , Moafa Hamza , Alshael Dalal
Published: July 2023

Objective

This study explores the effectiveness of a comprehensive licensure review and adaptive quizzing assignments intervention in improving the performance of undergraduate senior nursing students on the end-of-programme exit exam.

Design

A quasi-experimental single-group design was used to compare pretest and post-test scores through computerised adaptive tests.

Setting

The setting was a nursing college in Saudi Arabia.

Participants

The study included 292 senior nursing students enrolled in the Bachelor of Science in Nursing programme.

Intervention

A comprehensive licensure review bundled with adaptive quizzing assignments was delivered over 15 weeks in the academic year 2021–2022. The bundle was guided by the elaboration theory, and it included 3-hour synchronous lectures every week and 23 adaptive quizzing assignments that covered weekly content.

Primary and secondary outcome measures

Students’ mastery scores and the percentage of correct answers were the primary and secondary measures, respectively. Both measures were collected in the pretest and post-test (exit examination). Additionally, demographic characteristics were collected in the pre-test using an online survey.

Results

The overall mean of the mastery score was statistically significantly higher in the exit exam (M=2.51, SD=1.70) than in the pretest (M=1.45, SD=0.44; p<0.001). Although the overall mean of the mastery score in the exit exam did not reach the cut-off score, students who demonstrated the required knowledge and satisfactory performance in the pretest achieved a mastery score above the cut-off. The percentage of correct answers was statistically significantly higher in the exit exam (M=58.59%, SD=9.50) than in the pretest (M=49.32%, SD=9.78; p<0.001). A statistically significant difference in students’ performance based on gender, age and grade point average was observed.

Conclusions

A comprehensive licensure review and adaptive quizzing assignments intervention bundle fostered the performance of undergraduate nursing students in the end-of-programme exit exam.
Dysfunctional breathing symptoms, functional impact and quality of life in patients with long COVID-19: a prospective case series
Authors: Genecand Léon , Altarelli Marco , Binkova Alzbeta , Loew Selina , Vaudan Stéphanie , Gex Grégoire , Bridevaux Pierre-Olivier , Frésard Isabelle
Published: July 2023

Background

Dysfunctional breathing is increasingly recognised after SARS-CoV-2 infection, but the associated symptoms, functional impact and quality of life have not been systematically studied.

Methods

This study describes a prospective case series of 48 patients with dysfunctional breathing based on compatible symptoms and an abnormal breathing pattern during cardiopulmonary exercise testing. Patients with underlying disease that could explain these symptoms were excluded. Median time from COVID-19 to evaluation was 212 (IQR 121) days. Self-administered questionnaires, including the Nijmegen questionnaire, Short-Form (36) Health Survey (SF-36), Hospital Anxiety and Depression Scale, modified Medical Research Council scale, post-COVID-19 Functional Scale, and specific long COVID symptoms, were the outcome measures.

Results

On average, mean V’O2was preserved. Pulmonary function tests were within limits of normality. Hyperventilation, periodic deep sighs/erratic breathing and mixed types of dysfunctional breathing were diagnosed in 20.8%, 47.1% and 33.3% of patients, respectively. After dyspnoea, the five most frequent symptoms using the Nijmegen scale with a cut-off of ≥3 were faster/deeper breathing (75.6%), palpitations (63.8%), sighs (48.7%), unable to breathe deeply (46.3%) and yawning (46.2%). Median Nijmegen and Hospital Anxiety and Depression Scale scores were 28 (IQR 20) and 16.5 (IQR 11), respectively. SF-36 scores were lower than the reference value.

Conclusions

Long COVID patients with dysfunctional breathing have a high burden of symptoms, functional impact and a low quality of life, despite no or negligible organic damage.
Fluid biomarkers and neuroimaging in mild traumatic brain injury: current uses and potential future directions for clinical use in emergency medicine
Authors: Newcombe Virginia , Richter Sophie , Whitehouse Daniel P , Bloom Benjamin Michael , Lecky Fiona
Published: July 2023

Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%–40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome. Owing to the requirement for improved diagnostic and prognostic mechanisms, there has been increasing evidence concerning the utility of both imaging and blood biomarkers.

Blood biomarkers offer the potential to better risk stratify patients for requirement of neuroimaging than current clinical decisions rules. However, improved assessment of the clinical utility is required prior to wide adoption. MRI, using clinical sequences and advanced quantitative methods, can detect lesions not visible on CT in up to 30% of patients that may explain, at least in part, some of the ongoing problems. The ability of an acute biomarker (be it imaging, blood or other) to highlight those patients at greater risk of ongoing deficits would allow for greater personalisation of follow-up care and resource allocation.

We discuss here both the current evidence and the future potential clinical usage of blood biomarkers and advanced MRI to improve diagnostic pathways and outcome prediction following mild traumatic brain injury.
Machine learning for prediction of immunotherapeutic outcome in non-small-cell lung cancer based on circulating cytokine signatures
Authors: Wei Feifei , Azuma Koichi , Nakahara Yoshiro , Saito Haruhiro , Matsuo Norikazu , Tagami Tomoyuki , Kouro Taku , Igarashi Yuka , Tokito Takaaki , Kato Terufumi , Kondo Tetsuro , Murakami Shuji , Usui Ryo , Himuro Hidetomo , Horaguchi Shun , Tsuji Kayoko , Murotani Kenta , Ban Tatsuma , Tamura Tomohiko , Miyagi Yohei , Sasada Tetsuro
Published: July 2023

Background

Immune checkpoint inhibitor (ICI) therapy has substantially improved the overall survival (OS) in patients with non-small-cell lung cancer (NSCLC); however, its response rate is still modest. In this study, we developed a machine learning-based platform, namely the Cytokine-based ICI Response Index (CIRI), to predict the ICI response of patients with NSCLC based on the peripheral blood cytokine profiles.

Methods

We enrolled 123 and 99 patients with NSCLC who received anti-PD-1/PD-L1 monotherapy or combined chemotherapy in the training and validation cohorts, respectively. The plasma concentrations of 93 cytokines were examined in the peripheral blood obtained from patients at baseline (pre) and 6 weeks after treatment (early during treatment: edt). Ensemble learning random survival forest classifiers were developed to select feature cytokines and predict the OS of patients undergoing ICI therapy.

Results

Fourteen and 19 cytokines at baseline and on treatment, respectively, were selected to generate CIRI models (namely preCIRI14 and edtCIRI19), both of which successfully identified patients with worse OS in two completely independent cohorts. At the population level, the prediction accuracies of preCIRI14 and edtCIRI19, as indicated by the concordance indices (C-indices), were 0.700 and 0.751 in the validation cohort, respectively. At the individual level, patients with higher CIRI scores demonstrated worse OS [hazard ratio (HR): 0.274 and 0.163, and p<0.0001 and p=0.0044 in preCIRI14 and edtCIRI19, respectively]. By including other circulating and clinical features, improved prediction efficacy was observed in advanced models (preCIRI21 and edtCIRI27). The C-indices in the validation cohort were 0.764 and 0.757, respectively, whereas the HRs of preCIRI21 and edtCIRI27 were 0.141 (p<0.0001) and 0.158 (p=0.038), respectively.

Conclusions

The CIRI model is highly accurate and reproducible in determining the patients with NSCLC who would benefit from anti-PD-1/PD-L1 therapy with prolonged OS and may aid in clinical decision-making before and/or at the early stage of treatment.
Uncovering neuroanatomical correlates of impaired coordinated movement after pallidal deep brain stimulation
Authors: Santyr Brendan , Loh Aaron , Vetkas Artur , Gwun Dave , Fung Wilson KW , Qazi Shakeel , Germann Jurgen , Boutet Alexandre , Sarica Can , Yang Andrew , Elias Gavin , Kalia Suneil K , Fasano Alfonso , Lozano Andres M
Published: July 2023

Background

The loss of the ability to swim following deep brain stimulation (DBS), although rare, poses a worrisome risk of drowning. It is unclear what anatomic substrate and neural circuitry underlie this phenomenon. We report a case of cervical dystonia with lost ability to swim and dance during active stimulation of globus pallidus internus. We investigated the anatomical underpinning of this phenomenon using unique functional and structural imaging analysis.

Methods

Tesla (3T) functional MRI (fMRI) of the patient was used during active DBS and compared with a cohort of four matched patients without this side effect. Structural connectivity mapping was used to identify brain network engagement by stimulation.

Results

fMRI during stimulation revealed significant (Pbonferroni<0.0001) stimulation-evoked responses (DBS ON<OFF) in the supplementary motor area (SMA). Probabilistic tractography revealed that the patient’s VTAs engaged streamlines projecting to SMA. Compared with a cohort of matched controls, the stimulation-dependent change in blood oxygen level-dependent response at the SMA was 2.18 SD below the mean.

Conclusions

These stimulation-induced impairments are likely a manifestation of a broader deficit in interlimb coordination mediated by stimulation effects on the SMA. This neuroanatomical underpinning can help inform future patient-specific stimulation and targeting.
Transitioning from intrathecal bupivacaine to mepivacaine for same-day discharge total joint arthroplasty: a quality improvement study
Authors: Coleman Peter W , Underriner Tyler C , Kennerley Victoria M , Marshall Kyle D
Published: July 2023

Introduction

Same-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an institutional change from low-dose bupivacaine to mepivacaine, we aimed to assess the impact on postanesthesia care unit (PACU) recovery in a quaternary care, academic medical center.

Methods

In this quality improvement retrospective study, a single surgeon performed 96 combined total knee and hip arthroplasties booked as same-day discharge from September 20, 2021 to December 20, 2021. Starting on November 15, 2021 the subarachnoid block was performed with isobaric mepivacaine 37.5–45 mg instead of hyperbaric bupivacaine 9–10.5 mg. We compare these cohorts for time to discharge from PACU, perioperative oral morphine milligram equivalent (OMME) administration, PACU pain scores, conversion to general anesthesia (GA), and overnight admission.

Results

We found the use of isobaric mepivacaine as compared with hyperbaric bupivacaine for intrathecal block in same-day discharge total joint arthroplasty was associated with decreased length of PACU stay at our academic center (median 4.03 vs 5.33 hours; p=0.008), increased perioperative OMME (mean 22.5 vs 11.4 mg; p<0.001), increased PACU pain scores (mean 6.29 vs 3.41; p<0.01) and no difference in conversion to GA or overnight admission.

Conclusions

Intrathecal mepivacaine was associated with increased perioperative OMME consumption and PACU pain scores, but still realized a decreased PACU length of stay.
Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications
Authors: Zhao Yangang , Zhang Xiaolan , Lv Bin , Wang Jun , Liu Xinfeng , Du Zhihua , Cui Fang , Li Baoming , Chen Xing , Cao Xiangyu
Published: July 2023

Objectives

The presence of dural sinus septum has long been identified anatomically but is often neglected for its clinical significance. Our findings revealed the association of dural sinus septum with venous sinus stenting failure and complications supported by clinical evidence.

Methods

This retrospective study included 185 consecutive patients treated with cerebral venous sinus stenting from January 2009 to May 2022. We identified the dural sinus septa using digital subtraction angiography (DSA) and classified them into three types based on their location. The septa at the transverse sinus were defined as type I, those at the junction between the transverse sinus and sigmoid sinus were defined as type II and those at the sigmoid sinus were defined as type III. Based on the anatomic features and neuroimaging clues, we investigated the correlation of dural sinus septa with stenting failure and complications.

Results

32 (17.1%) out of 185 patients (121 with idiopathic intracranial hypertension and 64 with venous pulsatile tinnitus) were identified with dural sinus septa by DSA. More than half of the septa were type I (18/32, 56.2%), followed by type II (11/32, 34.4%) and type III (3/32, 9.4%). The dural sinus septa caused three stenting failures and complications, including one case of venous sinus injury with subdural haemorrhage and two cases of incomplete stent expansion. Statistical analysis revealed that the presence of dural sinus septum (p<0.01) was associated with complications of cerebral venous sinus stenting.

Discussion

The dural sinus septum is a common structure in the cerebral venous sinus. We found that the presence of dural sinus septa introduces uncertainties to cerebral venous sinus stenting and suggested precautions and ingenious skills in imaging and treatment.
Effects of cigarette price and packaging on hypothetical quit-smoking behaviour: a discrete choice experiment among Vietnamese adults who smoke
Authors: Czaplicki Lauren , Barker Hannah E , Welding Kevin , Islam Farahnaz , Dao Son , Ba Chan Nhu Huynh , Cohen Joanna E
Published: July 2023

Introduction

Raising cigarette prices, increasing graphic health warning label (HWL) coverage and requiring plain packaging could reduce cigarette smoking in Vietnam. This discrete choice experiment estimates the potential impact of these policies on smoking behaviour.

Methods

In February–May 2022, we conducted a phone-based, cross-sectional survey of 1494 Vietnamese adults who smoke. Participants were randomly assigned to view four individual cigarette pack images, varied on price (15 000 (
reference group
); 20 000; 30 000 or 40 000 Vietnamese dong (VND)) and packaging (branded pack with 50% graphic HWL (
reference group
); branded pack with 85% graphic HWL; plain pack with 50% graphic HWL or branded pack without HWL). Participants responded if they would quit or continue smoking if they could only purchase the pack shown. We used binomial logistic regressions to estimate the relative risk (RR) of price and packaging on hypothetical quitting.

Results

Participants were more likely to report they would quit when presented with 30 000 VND (RR 1.20, 95% CI 1.07 to 1.35) and 40 000 VND packs (RR 1.40, 95% CI 1.23 to 1.58) vs the 15 000 VND pack. Participants were also more likely to report they would quit when shown the branded pack with 85% HWL (RR 1.30, 95% CI 1.18 to 1.42) and plain pack with 50% HWL (RR 1.34, 95% CI 1.21 to 1.49) vs the branded pack with 50% HWL coverage. Participants had significantly lower quit likelihood (RR 0.41, 95% CI 0.35 to 0.48) when shown the branded pack without a HWL.

Conclusions

Results suggest raising cigarette prices to at least 30 000 VND, implementing larger graphic HWLs or plain packaging could decrease smoking rates in Vietnam.
Stellar anisotropic cluster in ƒ(ℛ, 𝔾) gravity
Authors: Ajmal M. , Bhatti M.Z.
Published: July 2023

We investigate a few models with various physical elements that could lead to the appearance of celestial bodies with different curvature systems within the background of [Formula: see text] gravity, where [Formula: see text] represents the Ricci scalar and [Formula: see text] stands for the Gauss–Bonnet curvatures. After formulating [Formula: see text] field equations in the setting of anisotropic fluid configuration, along with specific metric coefficients, the observational data of HerX − 1, 4 U1820 − 30, VeLAX − 1, SAXJ1808.4 − 3068, CenX − 3, and PSRJ16142230 are used. Three different gravity models are used to analyze their impact on mathematical modeling. Several physical factors have been illuminated, including energy density, pressure evolutions, energy conditions, stability analysis, the measurement equation of state parameters, matter content, etc. To access the substance of our model, we observed a number of physical factors, and it was discovered that our system does not contain any singularities.
Temporal vs spatial conservation and memory effect in electrodynamics
Authors: Taghiloo V. , Vahidinia M. H.
Published: July 2023

We consider the standard Maxwell’s theory in $$1+3$$

1
+
3

dimensions in the presence of a timelike boundary. In this context, we show that (generalized) Ampere-Maxwell’s charge appears as a Noether charge associated with the Maxwell U(1) gauge symmetry which satisfies a spatial conservation equation. Furthermore, we also introduce the notion of spatial memory field and its corresponding memory effect. Finally, similar to the temporal case through the lens of Strominger’s triangle proposal, we show how spatial memory and conservation are related.
Triad’s consonance and dissonance: a detailed analysis of compactness models
Authors: Masina Isabella
Published: July 2023

Theories of consonance and dissonance based on the “compactness” approach include the two sub-categories of periodicity and harmonicity. In a previous work, we discussed the related consonance and dissonance indicators for dyads; as they are given by discontinuous functions of the dyad frequency ratio, we proposed a method to extend them to the continuum, based on the auditory discrimination limen. Here, we generalize the compactness indicators to describe the consonance and dissonance for triads and discuss their extension to the continuum. We compare our model predictions with perceptual data from a recent psychoacoustic test by means of a Chi-square analysis. The result is that compactness indicators provide a quite effective, but not fully satisfactory, description of consonance, and dissonance for triads.
Modular source for near-infrared quantum communication
Authors: Berra Federico , Agnesi Costantino , Stanco Andrea , Avesani Marco , Cocchi Sebastiano , Villoresi Paolo , Vallone Giuseppe
Published: July 2023

We present a source of states for Quantum Key Distribution (QKD) based on a modular design exploiting the iPOGNAC, a stable, low-error, and calibration-free polarization modulation scheme, for both intensity and polarization encoding. This source is immune to the security vulnerabilities of other state sources such as side channels and some quantum hacking attacks. Remarkably, our intensity modulation scheme allows full tunability of the intensity ratio between the decoy and signal states, and mitigates patterning effects. The source was implemented and tested at the near-infrared optical band around 800 nm, of particular interest for satellite-based QKD. Furthermore, the modularity of the source simplifies its development, testing, and qualification, especially for space missions. For these reasons, our work paves the way for the development of the second generation of QKD satellites that can guarantee excellent performances at higher security levels.
A numerical model for gas CO
2
migration in a fault zone
Authors: Romano Valentina , Bigi Sabina , Park Heeho , Valocchi Albert J. , Hyman Jeffrey De'Haven , Karra Satish , Nole Michael , Hammond Glenn , Proietti Giampaolo , Battaglia Maurizio
Published: July 2023

Understanding whether fractures and faults impact the CO
2
migration through the overburden is critical in the evaluation and monitoring of CO
2
geological storage sites. We present a numerical model and workflow to describe the hydraulic behaviour of a fault located in the shallow part of the overburden. This helps to evaluate the sealing potential of the system in case of unwanted CO
2
migration toward the surface and to design an efficient monitoring plan. The model configuration is representative of several experiments performed at real sites under quite shallow conditions (50–500 m). The model results, applied to a selected fault outcropping in the Apennines (Italy), show that most of the gas migrates through the high permeable footwall damage zone. A significant amount of gas then dissolves into the water, emphasizing the importance of accurate modelling to assess the hazard of CO
2
leakage into near-surface aquifers or to the surface. The occurrence of pressure buildup close to the fault core points out that detailed modelling of the migration conditions is required to predict gas path through a fault zone.

Thematic collection:
This article is part of the Fault and top seals 2022 collection available at:
https://www.lyellcollection.org/topic/collections/fault-and-top-seals-2022