bluuebunny/crossref_metadata_2025 huggingface dataset:
Projeções Climáticas de Temperatura do Ar e Precipitação para o Estado de São Paulo Utilizando o Modelo Regional RegCM4
Authors: Godoy Renan Muinos Parrode de , Gozzo Luiz Felippe , Llopart Marta , Peron Bruna Luiza , Reboita Michelle Simões , Repinaldo Henrique Fuchs Bueno , Marrafon Vitor Hugo De Almeida
Published: May 2021

Este trabalho teve como objetivo avaliar mudanças nos valores de precipitação e temperatura médios sobre o estado de São Paulo (Brasil) e em três índices de extremos climáticos (dias secos consecutivos – CDD, extremos chuvosos – R95p e duração de ondas de calor – HWD), entre o período presente e o final do século XXI, a partir de um modelo climático regional. Foram utilizadas três simulações/projeções do Regional Climate Model (RegCM4) para o clima presente (1995-2014) e futuro (2080-2100), e a análise foi dividida nas estações de verão (DJF) e inverno (JJA). As simulações consideram o cenário mais pessimista de concentração de gases de efeito estufa na atmosfera do IPCC (RCP8.5). Dados observados do Climate Prediction Center (CPC) são utilizados para analisar a destreza das simulações no clima presente da precipitação e da temperatura do ar. No verão, as simulações superestimam a precipitação no litoral, enquanto no inverno a representam mais próxima do observado. Para a temperatura do ar, há subestimativas no litoral sul para ambas as estações do ano. No interior do estado, as temperaturas simuladas no verão são próximas ao observado, já no inverno observa-se superestimativa desta variável. Em relação aos índices climáticos, é observada pouca mudança do CDD para o verão, e um aumento para o inverno, principalmente do interior do estado, enquanto o R95p mostra sinal oposto ao CDD. O HWD apresenta uma diminuição em DJF no interior e um aumento na região litorânea para JJA. O interior de São Paulo é identificado como a região mais suscetível aos dias secos consecutivos e extremos chuvosos, enquanto as ondas de calor apresentam um sinal de aumento mais relevante no sul e faixa leste do estado, durante o inverno.
The Temporal Pattern of Recovery in Directional Dynamic Stability Post Football-Specific Fatigue
Authors: Rhodes David , Alexander Jill , Greig Matt
Published: May 2021

Background: Rising injury rates within football require further understanding of the etiological risk factors associated with lower-limb injury. Aim: To examine the temporal pattern of recovery of directional dynamic stability measures post football-specific fatigue. Methods: Eighteen male elite footballers completed baseline assessments of directional dynamic stability measures (Overall Stability Index, anterior–posterior stability [A-P], medial–lateral stability [M-L] on level 1 of the Biodex Stability System). Post Soccer-Specific Aerobic Field Test90 measures were repeated immediately, +24 hours, +48 hours, and +72 hours. The main effects for the recovery time and direction of stability were supplemented by regression modeling to describe the temporal pattern of recovery. Results: Significant main effects for time were identified for all directions of stability (Overall Stability Index, A-P, and M-L) up to +48 hours postexercise (P ≤ .05). The quadratic pattern of temporal recovery highlights a minimum of 37.55 to 38.67 hours and maximum of 75.09 to 77.33 hours. Additionally, a main effect for direction of stability was observed, with significant differences identified between A-P and M-L stability at all time points (P ≤ .001). Conclusions: Reductions in directional dynamic stability +48 hours postfatigue highlight implications for training design, recovery strategies, and injury management for performance practitioners. Interestingly, A-P stability has been highlighted as being significantly reduced compared with M-L stability at all time points, regardless of the fatigue exposure. Practitioners should consider the reduction of stability in this plane in relation to common mechanisms of injury in the knee to inform injury–risk-reduction strategies.
Reliability of the ForceFrame With and Without a Fixed Upper-Limb Mold in Shoulder Rotation Strength Assessments Compared With Traditional Hand-Held Dynamometry
Authors: Couch Jamon , Sayers Marc , Pizzari Tania
Published: May 2021

Context: An imbalance between shoulder internal rotation (IR) and external rotation (ER) strength in athletes is proposed to increase the risk of sustaining a shoulder injury. Hand-held (HHD) and externally fixed dynamometry are reliable forms of assessing shoulder IR and ER strength. A new externally fixed device with an attachable fixed upper-limb mold (The ForceFrame) exists; however, its reliability in measuring shoulder strength is yet to be investigated. Objective: To determine the test–retest reliability of the ForceFrame, with and without the fixed upper-limb mold, in the assessment of shoulder IR and ER strength, as compared with HHD. Design: Test–retest reliability study. Setting: Laboratory, clinical. Participants: Twenty-two healthy and active individuals were recruited from the university community and a private physiotherapy practice. Main Outcome Measures: Maximal isometric shoulder IR and ER strength was measured using the ForceFrame and traditional HHD in neutral and at 90° shoulder abduction. Mean (SD) strength measures were calculated. Test–retest reliability was analyzed using intraclass correlation coefficients (3, 1). The SEM and minimal detectable change were calculated. Results: Good to excellent test–retest reliability was found for all shoulder strength tests across HDD and ForceFrame dynamometry (intraclass correlation coefficients [3, 1] = .854–.916). The minimal detectable changes ranged between 25.61 and 41.84 N across tests. Test–retest reliability was not affected by the dynamometer or testing position. Conclusions: The results from this study indicate that both the ForceFrame and HHD are suitable for measuring shoulder strength in clinical practice. The use of the fixed upper-limb mold with the ForceFrame does not improve reliability.
Who do you trust? Wild birds use social knowledge to avoid being deceived
Authors: Cunha Filipe C. R. , Griesser Michael
Published: May 2021

Wild birds use social knowledge to avoid being deceived.
Cortical response to naturalistic stimuli is largely predictable with deep neural networks
Authors: Khosla Meenakshi , Ngo Gia H. , Jamison Keith , Kuceyeski Amy , Sabuncu Mert R.
Published: May 2021

Naturalistic stimuli induce a brain response shared across individuals that is largely predictable with deep learning.
Relations between absorption, emission, and excited state chemical potentials from nanocrystal 2D spectra
Authors: Ryu Jisu , Park Samuel D. , Baranov Dmitry , Rreza Iva , Owen Jonathan S. , Jonas David M.
Published: May 2021

The ensemble Stokes' shift gives the average single-molecule linewidth for quantum-confined nanomaterials.
Cost-effective implementation of the Paris Agreement using flexible greenhouse gas metrics
Authors: Tanaka Katsumasa , Boucher Olivier , Ciais Philippe , Johansson Daniel J. A. , Morfeldt Johannes
Published: May 2021

Adapting the choice of greenhouse gas metrics to evolving future pathways can reduce the costs for climate change mitigation.
Control of neurogenic competence in mammalian hypothalamic tanycytes
Authors: Yoo Sooyeon , Kim Juhyun , Lyu Pin , Hoang Thanh V. , Ma Alex , Trinh Vickie , Dai Weina , Jiang Lizhi , Leavey Patrick , Duncan Leighton , Won Jae-Kyung , Park Sung-Hye , Qian Jiang , Brown Solange P. , Blackshaw Seth
Published: May 2021

Loss of function of NFI transcription factors in hypothalamic tanycytes generates diverse subtypes of functional neurons.
Developmental bifurcation of human T follicular regulatory cells
Authors: Kumar Saumya , Fonseca Válter R. , Ribeiro Filipa , Basto Afonso P. , Água-Doce Ana , Monteiro Marta , Elessa Dikélélé , Miragaia Ricardo J. , Gomes Tomás , Piaggio Eliane , Segura Elodie , Gama-Carvalho Margarida , Teichmann Sarah A. , Graca Luis
Published: May 2021

Transcriptomics supports that human T
reg
cells differentiate into mature lymphoid tissue or circulating T follicular regulatory cells.
Supplemental Material: Tectonic controls on basement exhumation in the southern Rocky Mountains (United States): The power of combined zircon (U-Th)/He and K-feldspar 40Ar/39Ar thermochronology
Authors: Ricketts Jason , al. et
Published: May 2021

Detailed forward and inverse modeling methods, and Tables S1–S4 (K-feldspar sample information and analytical data, ZHe data, and complete ZHe modeling inputs, assumptions, and modeling parameters).
Supplemental Material: Shock-twinned zircon in ejecta from the 45-m-diameter Kamil crater in southern Egypt
Authors: Cavosie Aaron , Folco Luigi
Published: May 2021

Table S1: Electron backscatter diffraction (EBSD) analysis conditions
Checkpoint inhibitors and radiotherapy in refractory malignant melanocytic schwannoma with Carney complex: first evidence of efficacy
Authors: Bajpai Jyoti , Kapoor Akhil , Jalali Rakesh , Gounder Mrinal M
Published: May 2021

Melanocytic schwannoma (MS) is a rare nerve sheath tumour characterised by melanin-producing neoplastic schwann cells that typically affects the posterior spinal nerve roots. We report an ultrarare case of recurrent/metastatic MS associated with Carney complex in a young woman with family history of breast cancer. This highlights the novel approach of combined checkpoint inhibitors (CPI) and radiotherapy. The patient was initially treated with Nivolumab along with concurrent external beam radiotherapy. There was sustained clinical benefit achieved for over 15 months with preserved quality of life. Addition of Ipilimumab, which she tolerated reasonably well, helped to control the progressive disease again for another 12 months. She harboured a rare PRKAR1AR228mutation (Carney complex) and received appropriate targeted therapy. She survived for 51 and 35 months from her initial diagnosis and start of CPI, respectively, which to the best of our knowledge is the longest documented survival in this rare entity.
Challenges in maintaining medicine quality while aiming for universal health coverage: a qualitative analysis from Indonesia
Authors: Hasnida Amalia , Kok Maarten Olivier , Pisani Elizabeth
Published: May 2021

Introduction

Indonesia, the world’s fourth most populous nation, is close to achieving universal health coverage (UHC). A widely-publicised falsified vaccine case in 2016, coupled with a significant financial deficit in the national insurance system, has contributed to concern that the rapid scale-up of UHC might undermine medicine quality. We investigated the political and economic factors that drive production and trade of poor-quality medicines in Indonesia.

Methods

We reviewed academic publications, government regulations, technical agency documents and news reports to develop a semi-structured questionnaire. We interviewed healthcare providers, policy-makers, medicine regulators, pharmaceutical manufacturers, patients and academics (n=31). We included those with in-depth knowledge about the falsified vaccine case or the pharmaceutical business, medicine regulation, prescribing practice and the implementation of UHC. We coded data using NVivo software and analysed by constant comparative method.

Results

The scale-up of UHC has cut revenues for physicians and pharmaceutical manufacturers. In the vaccine case, free, quality-assured vaccines were available but some physicians, seeking extra revenue, promoted expensive alternatives. Taking advantage of poor governance in private hospitals, they purchased cut-price ‘vaccines’ from freelance salespeople.

A single-winner public procurement system which does not explicitly consider quality has slashed the price paid for covered medicines. Trade, industrial and religious policies simultaneously increased production costs, pressuring profit margins for manufacturers and distributors. They reacted by cutting costs (potentially threatening quality) or by market withdrawal (leading to shortages which provide a market for falsifiers). Shortages and physician-promoted irrational demand push patients to buy medicines in unregulated channels, increasing exposure to falsified medicines.

Conclusion

Market factors, including political pressure to reduce medicine prices and healthcare provider incentives, can drive markets for substandard and falsified medicines. To protect progress towards UHC, policy-makers must consider the potential impact on medicine quality when formulating rules governing health financing, procurement, taxation and industry.
Protocol for individual participant data meta-analysis of randomised controlled trials of patients with psychosis to investigate treatment effect modifiers for CBT versus treatment as usual or other psychosocial interventions
Authors: Sudell Maria , Tudur-Smith Catrin , Liao Xiaomeng , Longden Eleanor , Dunn Graham , Kendall Tim , Emsley Richard , Morrison Anthony , Varese Filippo
Published: May 2021

Introduction

Aggregate data meta-analyses have shown heterogeneous treatment effects for cognitive–behavioural therapy (CBT) for patients with schizophrenia spectrum diagnoses. This heterogeneity could stem from specific intervention or patient characteristics that could influence the clinical effectiveness of CBT, termed treatment effect modifiers. This individual participant data meta-analysis will investigate a range of potential treatment effect modifiers of the efficacy of CBT.

Methods and analysis

We will perform a systematic review and meta-analysis of studies investigating CBT versus treatment as usual, or CBT versus other psychosocial interventions, for patients with schizophrenia spectrum diagnoses. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and the online clinical trials registers of the US government, European Union, WHO and Current Controlled Trials will be searched. Two researchers will screen titles and abstracts identified by the search. Individual participant data will be requested for any eligible study, for the primary outcome (overall psychotic symptoms), secondary outcomes and treatment effect modifiers. Data will be checked and recoded according to an established statistical analysis plan. One-stage and two-stage random effects meta-analyses investigating potential treatment effect modifiers will be conducted. A list of potential treatment effect modifiers for CBT will be produced, motivating future research into particular modifiers.

Ethics and dissemination

This study does not require ethical approval as it is based on data from existing studies, although best ethical practice for secondary analysis of clinical data will be followed. The findings will be submitted for publication in peer-reviewed journals, and promoted to relevant stakeholders.

PROSPERO registration number

CRD42017060068.
Meta-analysis of the prognostic value of pretreatment serum ferritin in hepatobiliary and pancreas (HBP) cancers
Authors: Lin Shuwen , Fang Yinghua , Lin Ye , Mo Zhikang , Hong Xiaocheng , Jian Zhixiang , Ji Chenggang
Published: May 2021

Background and objectives

Studies have shown that serum ferritin (SF) has unfavourable prognostic value in hepatobiliary and pancreas (HBP) cancers. This meta-analysis aimed to comprehensively assess the prognostic role of pretreatment SF in patients with HBP cancers.

Methods

Eligible studies published before January 2020 were obtained through a comprehensive search in the PubMed, Web of Science, Cochrane Library and EMBASE databases. Pooled HRs and 95% CIs were then employed as effect sizes.

Results

Seven studies comprising 1244 patients were pooled. Elevated pretreatment SF was associated with worse overall survival (OS) (HR 1.60, 95% CI 1.36 to 1.88, p<0.001) and recurrence-free survival/progression-free survival/time to recurrence (HR 1.70, 95% CI 1.15 to 2.52, p=0.008). Significant prognostic value of elevated pretreatment SF on OS was detected in the subgroups regardless of the cancer type, race, SF cut-off value, tumour-node-metastasis stage and Newcastle-Ottawa Scale score.

Conclusion

Elevated pretreatment SF was associated with worse survival outcome of patients with HBP cancers. As such, it may serve as a novel prognostic biomarker for HBP cancers.
Retrospective delirium ascertainment from case notes: a retrospective cohort study
Authors:   Geriatric Medicine Research Collaborative
Published: May 2021

Objectives

This study sets out to ascertain if recognition of delirium impacts on patient outcomes.

Design

Retrospective cohort study.

Setting

Unscheduled admissions to acute care trust/secondary care UK hospitals.

Participants

Six hundred and fifty-six older adults aged ≥65 years admitted on 14 September 2018.

Measurements

Delirium was ascertained retrospectively from case notes using medical notes. Documented delirium was classified as recognised delirium and retrospectively ascertained delirium was classified as unrecognised delirium.

Primary and secondary outcome measures

Primary outcome measure: inpatient mortality. Secondary outcome measures: length of stay, discharge destination.

Results

Delirium was present in 21.1% (132/626) of patients at any point during admission. The presence of delirium was associated with increased mortality (HR 2.65, CI 1.40 to 5.01). Recognition of delirium did not significantly impact on outcomes.

Conclusions

Delirium is associated with adverse outcomes in hospitalised older adults. However, there is insufficient evidence that recognition of delirium affects outcomes. However, delirium recognition presents an opportunity to discuss a person’s overall prognosis and discuss this with the patient and their family. Further research is needed to assess the pathophysiology of delirium to enable development of targeted interventions towards improved outcomes in patients with delirium.
eTRIOtrial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology
Authors: Juraskova Ilona , Laidsaar-Powell R , Keast Rachael , Schofield Penelope , Costa Daniel SJ , Kay Judy , Turner Sandra , Koczwara Bogda , Saunders Christobel , Jefford Michael , Yates Patsy , Boyle Frances , White Kate , Miller Annie , Morton Rachael L , Butt Zoe , Butow Phyllis
Published: May 2021

Objective

Informal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc).

Methods and analysis

Thirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (anAustralian State Government Healthwebsite on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient–caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient–caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician–patient–caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient–caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention.

Ethics and dissemination

Ethical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules.

Trial registration number

ACTRN12619001507178.
Assessing risk of self-harm in acute paediatric settings: a multicentre exploratory evaluation of the CYP-MH SAPhE instrument
Authors: Manning Joseph C , Carter Tim , Walker Gemma , Coad Jane , Aubeeluck Aimee
Published: May 2021

Objective

To psychometrically assess the Children and Young People-Mental Health Self-harm Assessment in Paediatric healthcare Environments (CYP-MH SAPhE) instrument for the identification of immediate risk of self-harm in CYP, aged 10–19 years, in acute paediatric wards or emergency departments.

Design

The CYP-MH SAPhE Instrument was developed through a robust scoping review and Delphi consensus with 30 clinicians/topic experts. To evaluate the psychometric properties, a multicentre exploratory study was conducted.

Setting

Three acute hospitals in the UK.

Participants

163 CYP presenting at acute hospital settings with primary mental health (cases) or physical health (non-cases) conditions.

Primary and secondary outcome measures

Psychometric properties of the CYP-MH SAPhE instrument were evaluated through Principle Axis Factoring (PAF) with Oblimin (Kaiser normalisation) alongside measures of internal consistency (Cronbach’s α), convergent, discriminant and face validity.

Results

PAF of the dichotomous items (n=9) loaded onto three factors (1) behaviours and intentions; (2) suicidality and (3) self-harm. Factors 1 (Cronbach’s α=0.960) and 3 (Cronbach’s α=1) had high internal consistency. There was: good level of agreement between raters (kappa=0.65); a moderately positive correlation between the CYP-MH SAPhE instrument and the Columbia-Suicide Severity Rating Scale; and discrimination between cases and non-cases across the three factors (factor 1: m=88 vs 70; factor 2: m=102 vs 70; factor 3: m=104 vs 68). Assessment of face validity resulted in six items being removed, culminating in an eight question, rapid assessment instrument.

Conclusions

The results support the CYP-MH SAPhE Tool as a potentially reliable and valid instrument to identify immediate risk of self-harm in CYP presenting to acute paediatric healthcare environments, which is a burgeoning and significant global health issue.
Training and education of healthcare workers during viral epidemics: a systematic review
Authors: Nayahangan Leizl Joy , Konge Lars , Russell Lene , Andersen Steven
Published: May 2021

Background

It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes.

Objective

To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW.

Data sources

Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics.

Study eligibility criteria

All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020.

Participants

Healthcare workers.

Interventions

Educational or training interventions.

Study appraisal and synthesis methods

Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist.

Results

A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes.

Conclusions and implications of findings

The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.
Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)
Authors: Harmeling J X , Cinca Kevin Peter , Andrinopoulou Eleni-Rosalina , Corten Eveline M L , Mureau M A
Published: May 2021

Introduction

Two-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.

Methods and analysis

The Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.

Ethics and dissemination

The trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.

Trial registration

NTR7265.
Acuity level of care as a predictor of case fatality and prolonged hospital stay in patients with COVID-19: a hospital-based observational follow-up study from Pakistan
Authors: Almas Aysha , Mushtaq Zain , Moller Jette
Published: May 2021

Objectives

To determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.

Design

A hospital-based observational follow-up study.

Setting

Internal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020.

Participants

Adult patients with confirmed COVID-19, aged ≥18 years.

Methods

ALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and length of stay.

Results

A total of 822 patients with COVID-19 were admitted during the study period and 699 met inclusion criteria. The mean age was 54.5 years and 67% were males; 50.4% were triaged to low, 42.5% to intermediate and 7.2% to high acuity care. The overall case-fatality rate was 11.6%, with the highest (52%) in high acuity level followed by 16.2% in intermediate and 2% in low acuity care. Acuity level was associated with case fatality, with an HR (95% CI) of 5.0 (2.0 to 12.1) for high versus low acuity care and an HR of 2.7 (1.2, 6.4) for intermediate versus low acuity care, after adjusting for age, sex and common comorbidities including diabetes, hypertension, ischaemic heart disease and chronic lung disease. Similarly, acuity level was also associated with length of hospital stay.

Conclusion

High and intermediate acuity level is associated with higher case fatality rate and prolonged length of hospital stay in patients admitted with COVID-19. In resource-limited settings where the provision of high acuity care is limited, the intermediate care acuity could serve as a useful strategy to treat relatively less critical patients with COVID-19.
Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People"s Secure Estate (CYPSE) in England: study protocol
Authors: D"Souza Sophie , Lane Rebecca , Jacob Jenna , Livanou Maria , Riches Wendy , Rogers Andrew , Ullman Roz , Rashid Anisatu , Singleton Rosie , Wheeler James , Bevington Dickon , Deighton Jessica , Fonagy Peter , Fuggle Peter , Law Duncan , Edbrooke-Childs Julian
Published: May 2021

Introduction

Young people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People"s Secure Estate: a ‘whole systems’ approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme.

Methods and analysis

A mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences.

Ethics and dissemination

Ethical approval was granted by the Health Research Authority, Her Majesty’s Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations.
Impact of The Daily Mile on children’s physical and mental health, and educational attainment in primary schools: iMprOVE cohort study protocol
Authors: Ram Bina , Chalkley Anna , van Sluijs Esther , Phillips Rachel , Venkatraman Tishya , Hargreaves Dougal S , Viner Russell M , Saxena Sonia
Published: May 2021

Introduction

School-based active mile initiatives such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting physical activity recommendations. The iMprOVE Study aims to examine the impact of TDM on children’s physical and mental health and educational attainment throughout primary school.

Methods and analysis

iMprOVE is a longitudinal quasi-experimental cohort study. We will send a survey to all state-funded primary schools in Greater London to identify participation in TDM. The survey responses will be used for non-random allocation to either the intervention group (Daily Mile schools) or to the control group (non-Daily Mile schools). We aim to recruit 3533 year 1 children (aged 5–6 years) from 77 primary schools and follow them up annually until the end of their primary school years. Data collection taking place at baseline (children in school year 1) and each primary school year thereafter includes device-based measures of moderate-to-vigorous physical activity (MVPA) and questionnaires to measure mental health (Strengths and Difficulties Questionnaire) and educational attainment (ratings from ‘below expected’ to ‘above expected levels’). The primary outcome is the mean change in MVPA minutes from baseline to year 6 during the school day among the intervention group compared with controls. We will use multilevel linear regression models adjusting for sociodemographic data and participation in TDM. The study is powered to detect a 10% (5.5 min) difference between the intervention and control group which would be considered clinically significant.

Ethics and dissemination

Ethics has been approved from Imperial College Research Ethics Committee, reference 20IC6127. Key findings will be disseminated to the public through research networks, social, print and media broadcasts, community engagement opportunities and schools. We will work with policy-makers for direct application and impact of our findings.
Experience of establishing and coordinating a nationwide network for bidirectional intussusception surveillance in India: lessons for multisite research studies
Authors: Das Manoja Kumar
Published: May 2021

Objectives

To document and share the process of establishing the nationally representative multisite surveillance network for intussusception in India, coordination, data management and lessons learnt from the implementation.

Design

This study combined both retrospective and prospective surveillance approaches.

Setting

19 tertiary care institutions were selected in India considering the geographic representation and public and private mix

Participants

All children under-2 years of age with intussusception

Primary and secondary outcome measures

The experience of site selection, regulatory approvals, data collection, quality assurance and network coordination were documented.

Results

The site selection process involved systematic and objective four steps including shortlisting of potential institutions, information seeking and telephonic interaction, site visits and site selection using objective criteria. Out of over 400 hospitals screened across India, 40 potential institutions were shortlisted and information was sought by questionnaire and interaction with investigators. Out of these, 25 institutes were visited and 19 sites were finally selected to participate in the study. The multistep selection process allowed filtering and identification of sites with adequate capacity and motivated investigators. The retrospective surveillance documented 1588 cases (range: 14–652 cases/site) and prospective surveillance recruited 621 cases (range: 5–191 cases/site). The multilayer quality assurance measures monitored and ensured protocol adherence, complete record retrieval and data completeness. The key challenges experienced included time taken for obtaining regulatory and ethical approvals, which delayed completion of the study. Ten sites continued with another multisite vaccine safety surveillance study.

Conclusion

The experience and results of this systematic and objective site selection method in India are promising. The systematic multistep site selection and data quality assurance methods presented here are feasible and practical. The lessons from the establishment and coordination of this surveillance network can be useful in planning, selecting the sites and conducting multisite and surveillance studies in India and developing countries.
Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross-sectional web-based survey
Authors: Wente-Schulz Sarah , Aksenova Marina , Awan Atif , Ambarsari Cahyani Gita , Becherucci Francesca , Emma Francesco , Fila Marc , Francisco Telma , Gokce Ibrahim , Gülhan Bora , Hansen Matthias , Jahnukainen Timo , Kallash Mahmoud , Kamperis Konstantinos , Mason Sherene , Mastrangelo Antonio , Mencarelli Francesca , Niwinska-Faryna Bogna , Riordan Michael , Rus Rina R , Saygili Seha , Serdaroglu Erkin , Taner Sevgin , Topaloglu Rezan , Vidal Enrico , Woroniecki Robert , Yel Sibel , Zieg Jakub , Pape Lars
Published: May 2021

Background

Acute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN.

Patients, design and setting

We collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate.

Results

Thirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m23–6 months later (p<0.001). After 3–6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3–6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil.

Conclusions

Despite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3–6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.
Perceived effectiveness of public health measures and positive attitudes during a pandemic: a large cross-sectional study in Shanghai, China
Authors: Chu Qiao , Gu Tian , Li Anqi , Chen Junjie , Wang Hui , Liu Ningning , Wu Ruijun , He Yaping
Published: May 2021

Objectives

Building individuals’ positive attitudes during a pandemic is essential for facilitating psychological resilience. However, little is known about how public health measures may improve people’s positive attitudes during a pandemic. We investigated the potential mechanism underlying the association between individuals’ perceived effectiveness of public health measures and positive attitudes towards the success of pandemic control during the COVID-19 pandemic, by examining the parallel mediating effects of three types of threat appraisals: concerns about contracting the virus, perceived impact of the pandemic on life and estimated duration of the pandemic.

Design, setting and participants

In February 2020 when the COVID-19 infection was spreading rapidly in China, a large cross-sectional survey was conducted among 132 054 adults from the 16 districts in Shanghai, China.

Outcome measures

Perceived effectiveness of the public health measures, positive attitudes towards the success of pandemic control and threat appraisals.

Results

Results of structural equation modelling supported the hypothesised mediation model: perceived effectiveness of public health measures was associated with lower levels of concerns about contracting the virus (β=−0.20), perceived impact of the pandemic (β=−0.13) and perceived duration of the pandemic (β=−0.20), which were then associated with higher levels of positive attitudes towards the success of pandemic control (βs=−0.12 to −0.25).

Conclusions

The findings suggest that threat appraisals may be important pathways through which individuals’ evaluations of prevention strategies may influence their attitudes towards the success of pandemic control. The health authorities should consider reducing people’s inappropriate threat appraisals when designing public health policies to facilitate people’s positive attitudes during a pandemic.
Exenatide once weekly over 2 years as a potential disease-modifying treatment for Parkinson’s disease: protocol for a multicentre, randomised, double blind, parallel group, placebo controlled, phase 3 trial: The ‘Exenatide-PD3’ study
Authors: Vijiaratnam Nirosen , Girges Christine , Auld Grace , Chau Marisa , Maclagan Kate , King Alexa , Skene Simon , Chowdhury Kashfia , Hibbert Steve , Morris Huw , Limousin Patricia , Athauda Dilan , Carroll Camille B , Hu Michele T , Silverdale Monty , Duncan Gordon W , Chaudhuri Ray , Lo Christine , Del Din Silvia , Yarnall Alison J , Rochester Lynn , Gibson Rachel , Dickson John , Hunter Rachael , Libri Vincenzo , Foltynie Thomas
Published: May 2021

Introduction

Parkinson’s disease (PD) is a common neurodegenerative disorder with substantial morbidity. No disease-modifying treatments currently exist. The glucagon like peptide-1 receptor agonist exenatide has been associated in single-centre studies with reduced motor deterioration over 1 year. The aim of this multicentre UK trial is to confirm whether these previous positive results are maintained in a larger number of participants over 2 years and if effects accumulate with prolonged drug exposure.

Methods and analysis

This is a phase 3, multicentre, double-blind, randomised, placebo-controlled trial of exenatide at a dose of 2 mg weekly in 200 participants with mild to moderate PD. Treatment duration is 96 weeks. Randomisation is 1:1, drug to placebo. Assessments are performed at baseline, week 12, 24, 36, 48, 60, 72, 84 and 96 weeks.

The primary outcome is the comparison of Movement Disorders Society Unified Parkinson’s Disease Rating Scale part 3 motor subscore in the practically defined OFF medication state at 96 weeks between participants according to treatment allocation. Secondary outcomes will compare the change between groups among other motor, non-motor and cognitive scores. The primary outcome will be reported using descriptive statistics and comparisons between treatment groups using a mixed model, adjusting for baseline scores. Secondary outcomes will be summarised between treatment groups using summary statistics and appropriate statistical tests to assess for significant differences.

Ethics and dissemination

This trial has been approved by the South Central-Berkshire Research Ethics Committee and the Health Research Authority. Results will be disseminated in peer-reviewed journals, presented at scientific meetings and to patients in lay-summary format.

Trial registration numbers

NCT04232969,ISRCTN14552789.
Misconceptions about COVID-19 among older Rohingya (forcefully displaced Myanmar nationals) adults in Bangladesh: findings from a cross-sectional study
Authors: Mistry Sabuj Kanti , Ali A R M Mehrab , Yadav Uday Narayan , Ghimire Saruna , Hossain Md. Belal , Saha Manika , Reza Sompa , Bakshi Progati , Bhuiyan Abu Toha M R H , Harris Mark
Published: May 2021

Objectives

Due to low health literacy and adverse situation in the camps, there are possibilities of misconceptions related to COVID-19 among the older Rohingya (forcefully displaced Myanmar nationals or FDMNs) adults in Bangladesh. The present research aimed to assess the level of misconceptions and the factors associated with it among the older FDMNs in Bangladesh.

Design

Cross-sectional.

Setting

A selected Rohingya camp situated in Cox’s Bazar, a southeastern district of Bangladesh.

Participants

Information was collected from 416 conveniently selected FDMNs who were aged 60 years and above.

Primary and secondary outcome measures

The primary outcome was misconceptions related to the spread, prevention and treatment of COVID-19. Information on 14 different locally relevant misconceptions was gathered, each was scored as one, and obtained a cumulative score, ranging from 0 to 14, with a higher score indicating a higher level of misconceptions. A multiple linear regression model explored the factors associated with misconceptions.

Results

The participants had an average of five misconceptions. The most prevalent misconceptions were: everyone should wear personal protective equipment when outside (84.6%) and its prevention by nutritious food (62.5%) and drinking water (59.3%). Other notable misconceptions included the spread of COVID-19 through mosquito bites (42%) and its transmissions only to the non/less religious person (31.4%). In regression analyses, memory or concentration problems, communication frequency with social networks, pre-existing conditions and receiving information from health workers were significantly associated with higher COVID-19 misconceptions. These misconceptions were less likely among those overwhelmed by COVID-19, having COVID-19 diagnosed friends or family members and receiving information from friends and family.

Conclusions

Overall, we found that misconceptions were prevalent among the older FDMNs in Bangladesh. The associations have important implications for programmes to prevent and manage COVID-19 in these settings. Health workers need to be adequately trained to provide clear communication and counter misconceptions.
Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers
Authors: Gosling Jennifer , Mays Nicholas , Erens Bob , Reid David , Exley Josephine
Published: May 2021

Background

This paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.

Methods

This was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.

Results

Responses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.

Conclusion

GPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.